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The model of the family doctor getting out of medical school and setting up an office by himself, perhaps with his wife as combination nurse/office manager is getting rarer and rarer.
Increasingly, physicians are joining group practices, and those groups, in turn, are joining larger groups, groups often owned by a hospital or large health care organization.
Shelby Family Medicine, as of July 1, became the first group of family doctors in Shelby County to sign on with The Physician Group, which is owned by Jewish Hospital and St. Mary's HealthCare. The group also has a satellite office in Simpsonville also owned by The Physician Group.
The three physicians and one physicians assistant said the decision reflects their desire to practice medicine rather than business skills.
"In order to keep doing what we're doing, we need to find ourselves a niche market or get bigger," said Dr. Ron Waldridge. "This will relieve us of management responsibilities, which are a burden for physicians trying to practice medicine."
The Physician Group will now handle day-to-day running of the office and staff.
Dr. Ron Waldridge II said the move will also allow the physicians to take advantage of economies of scale in ordering equipment and providing insurance and other benefits to their employees.
Travis Carr, physician recruiter for The Physician Group, said more and more physicians coming out of medical school want to practice medicine and leave the business side to someone else.
"It frees up their time to do what they were trained to do," Carr said.
Waldridge II said another advantage of joining The Physician Group is that it helps with physician recruitment.
"We interviewed four physicians over the last 18 months and they all joined hospital-owned groups," Waldridge II said. "They want to know what they're going to get paid, they don't want to deal with being partners in the business and all of that."
While Shelby Family Medicine is the first family practice group in the county to join a hospital-owned physicians group, several local specialists who practice here belong to hospital-owned groups. And the trend in the region is toward more and more doctors selling their practices to a hospital.
Carr said The Physician Group employs over 200 physicians, including specialists, in the region. Jewish started owning physicians groups after it acquired St. Mary's Hospital, which, at the time, owned a group of about 50 physicians.
Hospitals owning physicians groups is a growing trend nationally, though in some places physicians are also buying and operating hospitals.
For the hospital, the advantage of owning a physicians' group is the hope for "downstream revenue," Carr said, though typically hospitals in the near-term lose money by owning physician practices. By acquiring a doctor's practice, the hospital does not automatically get all of his or her referrals. Federal law does not allow physicians to force patients to go to any certain hospital, even if the hospital is the physician's employer.
But Carr said another advantage of hospitals owning a physicians group is the public relations factor.
"You have guys (at Shelby Family Medicine) who have been practicing medicine for about 40 years," Carr said. "That gives us good name recognition."
While the physicians at Shelby Family Medicine feel they and their patients will benefit with ownership by The Physician Group, other doctors in town are not convinced of the benefits of joining a larger organization.
Dr. James Smith, with Family Physician Associates, said his group considered the move but decided the "disadvantages outweighed the advantages."
He said by remaining independent, his group feels free to use the strengths of different hospitals, urgent care centers and imaging centers for its patients. Even though physicians are not allowed to force patients to go to a certain hospital, he said they would feel "subtle pressure" to send their patients to their employers.
Smith said as far as management of the practice, he feels his office manager can do a better job than management employed by hospitals.
"You put all of your eggs in their basket," Smith said. "They've been in the business of running hospitals but not doctors' groups and those are two different things."
But Waldridge said his group considers it an advantage to help the local hospital.
"That hospital is an asset to the community and we need to keep it here," he said.
No matter who owns the practice, Shelby Family Medicine will take care of its patients and employees as it always has, Waldridge promised.
"We're all family here, and that's not changing," he said.