Young gastroenterologists are increasingly choosing to work for hospitals over going into private practice, but according to Adam Levy, MD, they are missing out on autonomy and future financial gains.
Dr. Levy, a gastroenterologist in Macon, Ga., spoke with Becker's ASC Review about the factors driving gastroenterologists toward and away from private practice.
Editor's note: This interview was edited lightly for clarity and brevity.
Question: What's driving gastroenterologists to private practice?
Dr. Adam Levy: Many young gastroenterologists are running away from private practice. This is due to the high cost of educational loans and an environment where hospitals are offering large salaries to graduates. It is difficult for private practice to compete upfront due to declining reimbursements. However, physicians with longer-term outlooks are coming to private practice because they understand that private practice offers more autonomy and more potential future earnings. The freedom to steer one's practice without a hospital administrator is a key freedom that many physicians desire, and this is available in private practice. Further, ownership in a practice not only allows autonomy, but strong potential financial upside from owning additional revenue streams and from potential sale of the practice.
Q: Which CMS policies are hurting gastroenterologists the most?
AL: Without a doubt, skyrocketing costs are affecting GI private practices who utilize independent ASCs for endoscopy. Supply costs are at all-time highs, but Medicare ASC reimbursements do not adjust or offer any flexibility. Labor costs have also risen sharply. Before the inflation seen over the last two years, a typical ASC would hope to break even on a Medicare endoscopic procedure. This is now even more difficult due to cost raises on equipment. When ASCs are no longer profitable or lose money, private practice cannot sustain or recruit. This will only drive more physicians into hospital employment and shift more procedures to the hospital, therefore raising overall costs for Medicare. Medicare must improve ASC reimbursement in order to just sustain current ASC operations.