Fellowship allows journalist to dig into what drives oncologists out of private practice

Any health care journalist covering the business side of physician practices knows that doctors in private practice often struggle. Health plans and the federal Medicare program make it difficult for physicians to get paid for the work they do and they change the billing and payment rules frequently.

In addition, doctors often say they have so little time each day to manage patient care properly because payers require them to see 20 to 40 patients a day.

Given these complaints, it’s easy to see why so many primary care and specialty physicians have sold their practices to hospitals over the years. Being employed affords attractive benefits such as regular hours and more support staff.

What’s striking about covering physicians in private practice is the paradox in how poorly health plans and Medicare treat them. I often wonder: Why don’t health plans and Medicare make it easy on physicians to remain in private practice? Don’t they see that their actions seem to drive doctors to sell their practices to hospitals? Then, once physicians sell to hospitals, they deliver the same services to health plan members but at much higher costs. Given how often we’ve covered the issue of how doctors working for hospitals force costs to rise (see here, here and here, for example), then clearly health plans are aware of this trend as well.

Lola Butcher

This question led Lola Butcher to pursue a special project on cancer care. Her four-part series for Oncology Times was the result of a yearlong Reporting Fellowship on Health Care Performance sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.

The fellowship was significant because independent journalists have little time to devote to big projects. Instead, they have focus on producing a regular income from month to month. Conversely, a staff reporter might simply ask for the time to dig into such a meaty topic.

The fellowship allowed Butcher to investigate the changing face of cancer care. Specifically, she wanted to investigate the shift of cancer care from local clinics to hospital outpatient departments.

Her editors described the four-part series for Oncology Times as showing how federal policies intended to reduce cancer care costs actually increased them. To read more about the value she got from her fellowship project, check out this new “How I did it” article. And, for more information and story ideas on how to cover the 340B program, check out Butcher’s tip sheet, “340B drug pricing: Cutting through the controversy.”

(Editor’s note: The application period for the next class of Reporting Fellowship on Health Care Performance has just opened. Apply today so you can pursue your own project.)

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