Latest news with #privatepractice
Times
21 hours ago
- Health
- Times
Streeting should stand firm in face of doctors' risible demands
No country can claim to be in the forefront of democracy and development unless it can ensure the health of its citizens. Whatever its woes — and they are many — the National Health Service does keep most Britons in better health than many people on other continents. Partly that is thanks to pioneering excellence in medical research. And partly it is the result of a long tradition of top surgeons and physicians whose skills underpin specialist units attracting doctors from overseas. The consultants know it. They are proud of it. And, to their discredit, they are ready nowadays to exploit it. NHS consultants earn, on average, £145,000 a year. It may not be the salary of an investment banker. But it is considerably more than most people are paid. And there is ample opportunity to supplement this salary with private practice and filling in as a locum at the going rate of £200 an hour. Consultants have been awarded a pay increase of 4 per cent for the coming year, a figure above inflation. The British Medical Association, the doctors' union, has described this as an 'insult'. It insists that a pay rise of 35 per cent over the next three years is needed to restore consultant pay to 2008 levels in real terms. Otherwise, the BMA says, it will support a strike if an 'indicative ballot' shows that this is what senior doctors want. The consultants' claim is risible. It is not only unaffordable in today's straitened times and given the parlous state of NHS finances; it is based on the threat of holding the health, and sometimes the lives, of thousands of patients to ransom. It is a maximalist demand, backed by possible strike action, similar to the bullying approach of the rail unions. Consultants ought to be able to see that their claim has far less validity or public support than the claims by nurses and resident — once known as junior — doctors. They, too, insist that their pay needs to catch up with what they once enjoyed. They, too, risk losing public sympathy, following earlier strike action. But millions of Britons have seen their take-home pay fall in recent years. Comparisons do not help consultants. Famously, Aneurin Bevan, the architect of the NHS, bought off consultants opposed to his proposals for a state scheme, saying that he had 'stuffed their mouths with gold'. And since 1948 they have enjoyed this well-funded quasi-independence from state control, with generous state pensions. They have also enjoyed the fruits of expensive training, provided largely by the state in Britain's medical schools. Doctors, like everyone nowadays, are obliged to pay back their tuition fees — but many will not do so for years. An alarming number will never do so; on qualification they look for more lucrative contracts abroad, often in Australia. As a result Britain has partly depended on an inflow of doctors trained overseas, largely in India, a situation benefiting neither country. In the long term, the tight restriction on the numbers enrolling in medical schools should be eased; a developed country should never risk a doctor shortage. Also in the long term, doctors, especially consultants, should be compelled, by legislation if necessary, to devote a defined period of their careers to the NHS and serve in areas of greatest need. Other countries make provision for nationwide coverage. The immediate challenge, however, is pay. Wes Streeting, the health secretary, is holding talks with the BMA. He must stand firm in resisting its absurd new demands.
Forbes
01-06-2025
- Business
- Forbes
As Trump Cuts Healthcare, Private Equity Gains Hold At Doctor's Office
Just two in five U.S. physicians are in doctor-owned private practice as hospitals and private equity firms gobble up physician groups thanks in part to cuts in insurance payments to medical care providers that are about to get even worse. The American Medical Association, the nation's largest physician group, says in a new report that the share of physicians working in private practice was 42.2% last year, which is a sharp decline from more than a decade ago when more than 60% -- or three in five doctors – were in private practice, which the AMA defines as a 'practice wholly owned by physicians.' The AMA's analysis blames flat to falling payments from health insurance companies and government health programs like Medicare coverage for the elderly and Medicaid coverage for low-income Americans among the reasons physicians are selling to hospitals, health systems and private equity. In addition, AMA says its data cites 'costly resources, and burdensome regulatory and administrative requirements' as 'longstanding and important drivers of this change.' 'The share of doctors working in practices wholly owned by physicians is unraveling under compounding pressures,' said AMA President Dr. Bruce A. Scott said. 'The cumulative impact of burdensome regulations, rising financial strain, and relentless cuts in payment poses a dire threat to the sustainability of private practices," Scott said. "After adjusting for inflation in practice costs, Medicare physician payment has fallen 33 percent over the past quarter century, which has severely destabilized private practices and jeopardized patients' access to care. Payment updates are necessary for physicians to continue to practice independently.' But there appears to be little interest by the Republican-controlled Congress to boost payments to physicians. The AMA report comes as Republicans in Congress and the Donald Trump White push for more cuts in federal health insurance programs, including Medicaid and Medicare, which would most certainly spill over onto doctor practices as more Americans lose health insurance. Last week, a new analysis published by the Robert Wood Johnson Foundation of the budget reconciliation bill passed by the U.S. House of Representatives shows physicians and other healthcare providers 'could lose more than $770 billion in revenue over the next decade as a result of more than 11 million people losing health coverage through Medicaid and the Affordable Care Act marketplaces.' The budget still faces approval by the U.S. Senate and would need to be signed into law by Trump. Meanwhile, more and more physicians are working for hospitals or companies owned by private equity no matter their medical discipline. 'Private practices now account for less than half of physicians in most medical specialties, ranging from 30.7 percent in cardiology to 46.9 percent in radiology,' the AMA said of its report. 'Exceptions included orthopedic surgery (54 percent), ophthalmology (70.4 percent), and other surgical subspecialties (51.2 percent).' The share of physicians working in hospital-owned practices increased to more than one-third, or 34.5 percent last year. 'Twelve percent of physicians were employed directly by a hospital (or contracted directly with a hospital), double the share (5.6 percent) in 2012,' the AMA said. 'In 2024, 6.5 percent of physicians characterized their practice as private equity-owned, higher than the shares in 2020 and 2022, which were both around 4.5 percent, the report noted.'
