Scott Humphreys, MD

Historically, medicine and business were purposefully separated. The physician fulfilled their obligation to ethics and their community, and a fair reimbursement was expected. Advertising was not necessary – everyone knew where to find their local doctor or hospital. Much of medicine was supportive rather than curative and patients, for the most part, understood this.

But in recent times medicine has become potent and curative. Now, a procedure or physician’s judgment can routinely make the difference between life and death. Medicine offers other ways to cheat death by lengthening our lifespans in a way not previously possible. The promise of a lengthened vigorous life makes people desperate. Desperate people are willing to pay.

Pharmaceutical companies, insurance carriers, hospital systems, and a myriad of affiliated services like electronic medical records soon found that not only were there fortunes to be made in medicine, they would perish if not actively participating in this arms race. Capitation through managed care, billion-dollar endowments, and maneuvers like “upcoding” became the norm. Many of our doctor colleagues decided this was a good time to retire. Somehow, those of us who stuck around found our way. We did not like the ever-increasing bureaucratic demands but in general, our relationships with our patients were preserved and we were treated as the leaders we are. 

Over the past ten years at the Colorado Physician Health Program (CPHP), we have heard a term more and more: “private equity.” The heaviness with which the phrase is delivered is immediately noticeable.

Basically, medicine’s successes have not gone unnoticed by the business world. If classic business-school practices can be applied to pharmaceutical, medical equipment, and insurance, why can’t they be applied to the doctor-patient delivery of health care? So, they started buying our practices. Literally overnight, a physician can go from being in charge of their clinic – medical decisions, staffing, patient flow, etc. – to no longer having control of any of that. Studies, lab work, and consultations are all scrutinized through the optics of the financial bottom line. 

It has long been determined that the stress of any job is the ratio of responsibility to control. In the distant past, medicine was not considered a stressful profession. Over the past couple generations of physicians, we have gradually traded lifestyle for control. Not a terrible trade if we maintained an adequate amount of control. Through my experience at CPHP, it appears private equity can disrupt this balance in a way which the physician cannot compensate. We are seeing many previously level-headed physicians referred for disruptive behavior with “a change in practice ownership” being one of the chief complaints. 

I don’t pretend to have a sweeping solution for these challenges. But I think it is important for all of us to have an awareness of how a change in practice ownership can not only affect our practice environment but our health itself. If you have recently gone through a similar transition or anticipate one, please recognize that CPHP is here to help you.

The Colorado Physician Health Program (CPHP) and the Colorado Medical Society partner to provide Doc2Doc Wellbeing Consulting, a peer-to-peer program that supplements CPHP’s extensive services with pre-clinical support without lengthy documentation or an extensive evaluation. Any Colorado physician or medical student can call 720-810-9131 24/7 to speak to a masters-level licensed clinician and schedule a confidential appointment with a physician trained in psychiatry (in person, video or phone call, depending on preference). Discuss any concern — stress, burnout, relationship issue, or poor outcome.

Learn more at cphp.org.