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Posted: Wed Nov 30, 2016 10:39 am
by mack86
It's their loss. Go out on your own. See patients in a private office. You will enjoy the autonomy!

Posted: Wed Nov 30, 2016 10:39 am
by Bruni
The marketplace is changing, for sure. The future of insurance coverage (Obamacare) is unknowable and likely to worsen under Trumpcare. Independence has its merits.
I practice independently (i.e. alone) and rent space inside a large behavioral health group, surrounded by diversely qualified therapists and three full time psychiatrists (one of whom has 100 bup pts) and one part time bup psychiatrist (30 bup pts). All I lack to go to up to 275 pts is a case management service (none in the behavioral health organization); I do not think I could manage 275 pts however without support staff.
It is unlikely that the behavioral health group will add mid level bup providers or expand its bup psychiatrists services because insurance contracts for behavioral health services limit billing outside the contract for covered patients, and the reimbursement for bup services (considering the work involved) is pitiful. Moreover, the legalities of accepting cash for Medicare and Medicaid covered pts scares the administration (rightfully so). I am not signed on to any insurers nor to any federal programs, and as such, can bill cash payments to anyone; I adjust to meet the exigencies of individuals pocketbooks. More or less, I am happy with this arrangement in that I don't see it getting better by working for an organization.

Posted: Wed Nov 30, 2016 10:39 am
by NoDrugs4u
No, I mean literally out of a job. The clinic that I work for has informed me that I will be replaced by "Practitioners" once they become certified. And they had the balls to tell me that my salary was a 'strain on their budget' and "practitioners" were cheaper. Well I hope they get what they pay for, as the saying goes.....

Posted: Wed Nov 30, 2016 10:39 am
by mack86
Agreed. happened to me years ago in ER and urgent care. PA's and NP's are cheaper and they don't make waves, because they just follow hospital approved algorithms.

Now I mostly do functional medicine (that's bio-identical hormones, natural wellness, etc), cash pay only. I had a patient who needed growth hormone but I don't write for GH myself because I don't want the attention from any government agencies, so I referred him to an endocrinologist. Got the letter back yesterday, saying that they agreed and were starting him on GH. Then I looked at the signature - it was an NP "Board Certified, Endocrinology Specialist". WTF??? My patient never even saw a doctor. But he saw a "board certified specialist." I wonder if I can take the same course that NP took to get "board certified" -probably would take a few weeks, lol.

Posted: Wed Nov 30, 2016 10:39 am
by drpasser
It will happen, but hasn't happened yet. Try and make your services stand out from other providers.

For me, I lowered my prices considerably, too help compete.