The number of salaried physicians keeps growing in this country. And that statistic, for most doctors, signals a disturbing trend.
If it continues, the medical entrepreneur will cease to exist. Instead of ruggedly independent practitioners, medicine will be populated by doctors who are salaried employees of insurance companies, hospital administrators, corporate managers and government.
That has long been a fear of medical politicians who run state associations and specialty societies.
What's different now is that age-old fears are on the way to becoming reality.
The American Medical Association (AMA) reports that 25.7 percent of all doctors were working as salaried employees in 1985 - up from 23.4 percent of those above the age of 55.
The younger physicians these days are working for hospitals, clinics, or other health care organizations. Salaries tend to be lower than the incomes earned by independent practitioners, but a leveling off apparently is taking place in both groups.
For the traditional fee-for-service doctors, the notion of working for someone else has long been repugnant, if not downright unacceptable. Mostly, they cherish their independence and mourn the loss of autonomy.
Declining incomes, or rather the suggested leveling off, is attributed in large part to government restrictions. And it will not be reassuring to physicians who are being told that still more restrictions likely will emanate from the federal government.
Dr. Robert H. Ebert, former dean of Harvard Medical School, is one who sees even less control of the medical care system by doctors in the future. From his perspective, however, the encroachment comes not from government alone.
Employers and private insurance carriers have been moving aggressively to control costs. Along with a feared surplus of doctors, the commercialization of medicine by large corporations - especially the owners of hospitals and nursing homes - "could lead to a reduction in the per capita income of physicians," says Ebert. …