I understand intellectually that if I had retained every patient that I ever saw, this wouldn’t be the best thing for me. My practice would be hypertrophied beyond recognition and would probably have been closed to new patients years ago. On the other hand, it bothers me to think that insurance companies are creating a thieves’ market that will cause my most satisfied patients to race for the life rafts and abandon the small ship of my practice. Perhaps it is selfish of me, but what will my practice look like if all the stable, happy patients are siphoned off by economic incentives and redirected back to primary care? The only patients that will be left in my waiting room will be those who are too sick or too unhappy to be cared for by their PCP. These patients will probably include patients with chronic pain, the deeply depressed, patients with rare or complicated illness, and other difficult subsets of patients that PCPs tend to avoid caring for. That will be a much tougher practice environment, but perhaps that is the bleak future for specialists, and I should get ready for it. I’ll tighten my belt a notch and ask the dry cleaner to put some extra starch in my white coat.
Dr. Greenbaum is a rheumatologist who practices in Greenwood, Ind.