Bob Adams: Strength in physician numbers

January 20, 2014 

Regarding the Jan. 12 news article “After loss of key doctors, WakeMed seeks to stabilize”: After retiring in 2006 from the Army Medical Corps (the largest managed care organization in the world), I started civilian life as one of Knightdale’s first full-service family practice doctors. I was part of a large organization of doctors formed to negotiate better rates with insurers and simplify the business model. It worked well for three years, but insurers constantly battled to reduce negotiated rates. The parent group then sold itself to a hospital, and I left to go it on my own.

I had an MBA and 20 years of experiences running award-winning clinics for the Army. On the day I became an independent practitioner, all the insurance companies walked in with new contracts reducing payments by 50 percent or more. These payments were for the same patients, paying them the same premiums they had always paid. They further noted that any physician extender (PA or NP) in my office would be paid an additional 15 percent less. I asked why they were doing this, and the short answer was, “Because we can.”

At the next N.C. Academy of Family Physicians meeting in Asheville, I asked a BCBS conference representative the same “why” question, and the response to over 700 doctors in stunned attendance was, “We are a monopoly, a status granted by law, and market forces dictate we do this to the independent physician.” They noted that they were made exempt from our antitrust laws. It appeared they were forcing the independent doctor to affiliate or fail.

I survived, but did not thrive, for a year. I worked so hard to survive in business that my patients began to worry about the stress seen on my face, while I tried to maintain the multiple, award-winning “Best Doctor” status we were noted for in Eastern Wake County. I was working harder than ever in my life, and insurance reimbursements plummeted. I was looking for a hospital-based home to save me.

I am now with the superb UNC Physician Network, and my more than 6,000 practice patients once again enjoy coming to see me and our other three providers in a more relaxed and professional operation, managed by system experts, as part of a growing, successful, patient-focused organization. I am able to concentrate on my patients again.

Happiness has returned to my staff, my patients and me. I would never consider a return to private independent practice in today’s environment.

Bob Adams

Medical director, Knightdale Family Medicine


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