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Saturday, February 04, 2006

Medical Economics article:the demise of the doctors' lounge

The Feb 03, 2006 issue of Medical Economics has a interesting discussion of why the tradition of the doctors lounge is dying out. This seems to be something else we can blame managed care for.The authors cite managed care and the rise of the hospitalists as causes. I would spin it this way: the hospitalist movement is in no small measure also a indirect result of managed care.

How does that work? With managed care driven reimbursement decrements it economically behooved primary care docs to see more patients in the office as the pay per patient- encounter decreased.The hospitalist-according to Dr. Wackter-sprang up because their presence allowed the primary care docs to see more office patients by not having to round at the hospital.

Dr. Robert Wachter's version of how hospitalists appeared on the scene is found here and it will likely be the historical orthodoxy. Further, the days of the doctors' lounge being the primary site for networking and consulting each other are largely gone as the physicians that other docs refer to is largely determined by what plan the patient has.

This ties in with an earlier blog I wrote that discussed the observation that not only has managed care driven a wedge between doctor and patients but it has also did the same thing between physicians leading to a gradual withering away of the collegiality that in the best of times existed in the medical profession. I think the demise of the doctors lounge is symbolic of all of that.

The local internal medicine society that I have belonged to for over 25 years once had 75 or more in attendance at our monthly meetings,now has maybe 20 on a good night and usually the older and retired docs are in the majority.The younger internists who in part came to the meetings to become known and make important networking links see no need to do so now. It is basically attended by a few academic internists who are in the med center anyway at that time of day and the retired docs who don't have anything else to do. I believe the demise of this professional organization is probably another victim of managed care.


Anonymous said...

The hallmark of advanced industrial production is specialization. The question is whether hospitalists improve patient outcomes--or are a vehical for insurance co's to make more $. It's an open question, it seems.

Anonymous said...

It is painful hearing senior internal medicine residents ask: "Why should I join the ACP? What do I get, besides paying 400$/year for membership?"

Divide and conquer. Big Pharma and Big HMO did a good job.

Dr. Luke Van Tessel said...

Great. So by the time I get to be an attending I won't get to hang in the lounge or even have a designated parking spot.

Without our network and camaraderie, how are we supposed to fight HMOs? Oh, wait. I just figured it out.

Anonymous said...

I have been a FP in my community for 25 years. In the beginning, I knew most of my fellow PCP's and most of the specialists in the community. Many of them have retired. Most of the newer PCP's in the community don't go to the hospital. Patients pick them from HMO lists. I don't know most of the newer doctors and probably never will. The newer specialists for the most part don't network either. I have to pick them from my HMO lists. A patient wants to know if the specialist I'm referring him or her to is "good." I have to say, "I don't know - I've never met him but he is the only endocrinologist on your plan who we can get an appointment with." Who would have believed 25 years ago that a doctor's practice would be developed from being picked out of a list?

Anonymous said...

Consider the positive side. A better equivalent of the lounge could be developed through blogs and the Internet: Doctors' Lounge 2.0

james gaulte said...

I agree with Medical Blog networks' comment that a virtual doctor's lounge would have certain advantages over the rapidly disappearing real version. However, the determinative driver for referals would still be what plans does the potential consultant belong to.

Anonymous said...

True, online communities in themselves cannot circumvent the plan design.

However, they can provide a better way to reach out to colleagues who are available for a patient. That is whenever there is any choice...

In real life, keeping in touch with hundreds or thousands of people is really hard.

Online it can be a little easier.