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Palliative Care or Rebirth: How Can Private Practice Physicians Go On These Days?

Melissa Welker, MD MPH shares how you can approach and use the upheaval in medicine as an impetus to redesign and rediscover your medical practice values.

March 14, 2024

As physicians we know that end of life care is down right hard.

It is impossible to know how long a patient has left and tricky to know when to push and when to let go.

Right now, private practice groups are having a similar quagmire.

With countless contract changes, mergers and acquisitions, and private equity takeovers and collapses it is hard to see the path out for medicine in general. Physician owned groups seem to be caught in the morbidity and mortality of the corporate fight for profit in medicine. The big question is, can physician owned groups survive?

It seems like medicine in the US today is headed to an unsustainable breaking point for patients and health care workers. As Amazon has come into our lives and made local business struggle to survive, smaller private practices are struggling against the reserves of private equity backed multi-speciality groups that may also come with their own insurance arms.

What is a physician or patient to do?

 

It is impossible to know how long a patient has left and tricky to know when to push and when to let go. Right now, private practice groups are having a similar quagmire. Click To Tweet

 

Thinking back to my days in palliative care, a large proportion of the initial visit was spent identifying and honing in on priorities and tradeoffs. Each private practice group must spend the time doing similar.

We must truly ask the hard and painful questions of what is really important to us, our patients, and our future going forward. After which, we must then take focused steps toward creating this path forward.

Similar to patients confronting a terminal diagnosis, before the palliative care visit, contract termination or staffing crisis it is hard to spend the time with the basics of what matters.

The COVID pandemic was a perfect example, and workplaces around the world struggled.

These discussions are hard and painful at times, but also a matter of survival.

 

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If you have not started asking these questions, start now. It is easy to point back to where we wished we had made a change or taken a different road and get stuck.

You cannot change the past but you can use it to help you make better decisions for the future.

For me, I try to frame this as discussion of what you can control vs what is outside of your control. COVID, patients surgeons, insurance and market forces you cannot control; while culture, scheduling, and how you communicate (or don’t) can be controllable.

 

Now comes the hard part, how do we start this discussion?

Like looking at personal finances, we must start with truly looking at what the facts are.

Identity where you are, good and bad in real numbers and realities.

If you are down multiple physicians, contracts or up in expenses, write it out.

You must know where you are starting, who you are, and what you have before you can move forward.

 

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Then sketch out ambitious but specific goals and how you will achieve them.

This is the who are you and what you really want to achieve.

Whatever direction you choose you and your group will have to go through the storm of change with you and you need a reason that is strong enough to bring you through it all.

Make it both ambitious and actionable i.e. we want to become the biggest independent subspecialty group in the northwest by growing by 20 physicians and acquiring one additional practice location by third quarter 2024.

 

When compared, palliative care and birth seem like opposite approaches on the medical spectrum.

Then you realize they both rest on the hope; hope that it can be better and life can find a way.

It is in the facing birth and death that we all tend to become more clear on our priorities and the rest falls away.

Let’s get clear and let the rest fall away.

Melissa Welker, MD MPH

Melissa Welker, MD MPH

Thinking creatively about how we can make Anesthesiology and healthcare work for patients and those that work in healthcare.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. For more information, or to submit your own opinion, please see our submission guidelines or email opmed@doximity.com. Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.

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