The Physician's Choice: Private Practice

Through her presidential initiative, PAMED President Lynn Lucas-Fehm, MD, JD is exploring the landscape of health care and the myriad of choices physicians face in today's rapidly changing health care environment.

In this episode, Dr. Lucas-Fehm interviewed former PAMED President and longstanding pillar in the Central Pennsylvania medical community, F. Wilson Jackson, III, MD. He talks to Dr. Lucas-Fehm on what it means to stay independent in a world of consolidation and corporate health care. 

For the full episode, visit www.pamedsoc.org/PhysiciansChoice

Visit www.pamedsoc.org for more.

Transcript

0:00

The views expressed by podcast guests are their own. Their appearance on the podcast does not imply an endorsement by PAMED of them, or any entity they represent. Welcome to PAMED Talks, a podcast brought to you by the Pennsylvania Medical Society. I'm Myla Merkel and in each episode we dive deep into the heart of medicine and patient care in Pennsylvania. As part of her presidential initiative, PAMED president Dr. Lynn Lucas-Fehm is continuing to explore the evolving landscape of health care and the myriad of choices physicians face in today's rapidly changing health care environment. In this episode, Dr. Lucas-Fehm interviewed former president and long standing pillar in the central Pennsylvania medical community. Dr. F Wilson Jackson. Dr. Jackson received his medical degree from Northwestern University in Chicago and completed his residency at Thomas Jefferson University. He's board certified in internal medicine and gastroenterology. He is also a fellow at the American Gastroenterology Association, American College of Physicians, and American Society of Gastrointestinal Endoscopy. Dr. Jackson is a second generation private practice owner in south central Pennsylvania that has been in business for 60 years. His experience has spanned decades, and the conversation about private practice explores legacy, change and financial forces that are reshaping care. He talks to Dr. Lucas-Fehm on what it means to stay independent in a world of consolidation and corporate health care. So, welcome, Dr. Jackson Lynn. Thank you. Thank you. I really appreciate the invitation. First and foremost, I want to congratulate you on a wonderful year you've been having so far this year as the organization's president, you've been a terrific torch bearer for the organization. And really speaking on behalf of physicians, particularly around your initiative. And we'll get into later. Really resonates well with me. And I thank you for all the hard work that you're doing, because it's a fair amount of work and commitment to embark. Right. So I think to start out, what we should probably let everyone know is what is your current practice? What modality are you are you working in? Is it, you know, private? Is it academic? So tell us a little bit about your practice. Yeah. We have a very kind of traditional private medical practice or historically traditional. I'm in a private practice. We have a total of five physicians. We have four non-physician providers. And we are located in south central Pennsylvania. And it’s where I've been for my entire career. Been here for over 25 years. And we've grown organically, and we have two office sites on either side of the Susquehanna River, the East Shore, West Shore. And we have it a an endoscopy center. So from a practice perspective, we do not only an office, you know, ENM routine office work, but also doing endoscopy procedures in a freestanding ASC. I’m the second generation sort of thing, I just kind of kept doing what my father created, but did expand, build the practice out and brought in some friends and partners along the way. We have a great, great group of partners I have to work with. Plus four APPs as well. We've kind of carved out a practice in our area that's because it's the second generation we've been in the community for, boy, you know, 60 years or so now. So kind of just a longstanding presence. And, that second generation of sorts. We've, and myself, and my partners all have deep roots in the community, and we enjoy that kind of traditional, value that we bring, hopefully bring our patients, but also part of the community bring kind of members our community. Our kids have gone to school in those local schools, they’ve engage in all the sports and other activities and schools we've become part of and become quite active in a whole variety, wide variety of, you know, activities outside of the medical practice itself. So it’s like we’re a part of the community, in addition to providing medical care. During the past two decades, the medical landscape has transformed. Independent practices are facing consolidation from health systems and evolving employment models. Despite that, Dr. Jackson's practice stands firm in its commitment to independent practice. You know, if you look through the trajectory of the past 25 years of my practice, you know, we've gone from a really a dominant, physician kind of private practice privately owned practice model to now a much bigger shift and really been inverted in a very big way. We've maintained that traditional ownership model, but in those 25 years, you know, certainly I've seen many practices become consolidated into a health system We merged with another small independent practice about almost 20 years ago to create a combined practice between the two. But we did that just to kind of pull some resources. But with the spirit of trying to maintain high quality care at an independent level. So I've seen the consolidation of practices being, kind of brought up by, private or by health systems in that community. By the same token, I've also seen the shifts to the the consolidation of the health systems. You know, you know, we in our area, we have two dominant health systems. That's pretty typical now in the community or elsewhere in the state Philadelphia, Erie, Williamsport, Scranton, Erie. Pittsburgh is oh, there's one, two, maybe no more than three large health systems that dominate the market. And they employ large percent of the physicians. So a lot of our colleagues are now kind of become kind of employed within that larger health system. And they're perfectly happy. Many of them are perfectly happy in that model. We've chosen not to go in that direction at this point. While benefits are opposed to working for a health system, there also seems to be barriers in which physicians can really get to know their patients for that continuity of care. There seems to be some subtle social components to that patient care. Not that the care delivered is any less, but that personal touch, in some ways has, I've seen, changed, and patients what comment to me and some of my colleagues have shared with me. We’ve been able to partner with them. Access to their hardware, so to speak, their devices. Not only has Dr. Jackson's practice remained steadfast in not joining with the health system, but the practice has also been approached by private equity. I mean, any student of health care delivery in the United States has become well aware. The penetration of private equity into the health care environment. And that's true throughout our other medical specialties dermatology, ENT, ophthalmology, dermatology, some exempt, emergency room, emergency physicians, probably some pathology as well. So this is not unique to gastroenterology by any measure, and the model is quite effective. And those investors in the private equity see an opportunity to pull together kind of a very splintered medical field and bring it together to improve some degree of efficiencies. When private equity enters clinical care, with it, a new kind of ownership structure emerges. But what happens when health care becomes an investment portfolio? So medical practices, struggling to make a purchase, a major capital purchase, part of the private equity is a great way to make those acquisitions and broaden your portfolio of products and service that you bring to patients. I think physician need to be really careful about the potential ethical conflict. They have between those two forces, so to speak, in terms of your stockholder and a larger entity and your advocacy for the patients. I think that's where the private equity folks, and your partners, should be really thoughtful on who you choose to partner with, because like any other industry, there's a range of motivations behind the scenes, so to speak. And I think, if you go into that, if you pursue that partnership, you want to do your homework and find a partner that shares those values with you, because I think those values are at risk of, being conflicted and being pulled in a way that I think it's not best for the patient. For many health systems, private equity offers a way to monetize years of hard work. But not all benefits are evenly distributed, especially with second and third ownership handoffs. There's only so much revenue you can generate with patient encounters. And, you know, there's an asymptote in terms of how many patients you can see necessarily and how many quality care metrics you can meet at any given time. So there's a limit to how much profit you can pull from a practice. So in private equity, that second sale, you know, you don't know who your owner is going to be at that point. What I've seen in some of these second exits, or the exit by the initial investing entity is oftentimes they're sold to a kind of an annuity type fund where they're just looking for a revenue stream at that point. My concern, one I share with my partners, is I don't necessarily think it's a great opportunity long term for the newer physicians and young career physicians. And I'm not quite sure what that's going to look like when you have secondary, and perhaps even tertiary buyers of your, of your entity there, your practice. For early career physicians just entering the practice, Dr. Jackson advises to understand the full spectrum of private equity and what that could mean for your practice of medicine. So, if I was counseling someone I would: One, you know seek independent counsel and advice, and two, do your homework and your sort of due diligence on who your future partner is going to be. What's their track record, and what's their core values? You know, what's their leadership style, who's on their board of directors, what's their makeup? What's their experience? What's their commitment to health care? Because that's where I think health care distinguishes itself from all the other business entities that private equity is entered is healthcare is a little bit different. You know, you got patients’ lives at stake here. And I think you need to approach it with a little different philosophy than you would necessarily if you're investing in another business sector than health care. Private equity isn't just buying practices. They're buying hospitals. And when systems collapse, communities pay the price. Part of me would hope for a little bit of a of pendulum swing in the other direction, as those early career physicians or younger physicians who became part of a private equity decide, that's not what I'm looking for, and they decide to come out and move into private practice. I'm hopeful there's gonna be a little bit of a pendulum swing in that direction. Those were the interview clips of Dr. Jackson's professional experiences with private equity, and his decades of owning private practice, and his hopes for the future of the practice of medicine. By sharing physician experiences and insights, Dr. Lucas-Fehm’s presidential Initiative highlights how physicians can support each other in making decisions that uphold the integrity of the medical profession and ensure the best outcomes for patients. To watch and listen to the full interview, visit the Presidential Initiative webpage at pamedsoc.org/PhysiciansChoice. Stay tuned for more episodes of PAMEDTalks as we continue to explore vital topics that shape our medical community and patient care in Pennsylvania. If you enjoyed today's conversation, please consider leaving us a rating or a review. It's one of the best ways to help others discover the show, and it lets us know what you're loving and what you'd like to hear more of. If you haven't already, be sure to follow or subscribe so you never miss an episode! Remember, every step forward in health care starts with a conversation. Thanks for being a part of ours. Until next time!