How asking one simple question can empower your health

Independent or Employed? 

How Asking One Simple Question Can Empower Your Health

By Stacy Apple and Christina Crawford

Photo by Stacy Apple

Like many busy, working parents, Joe Duer knows he’s put his own healthcare second to his family and career. Joe is a professional actor, model, and dedicated baseball dad. His two boys play on select, city, and travel teams, which means he’s running from the moment he steps out of bed, but not without the help of a few ibuprofen with his morning coffee. Joe suffers from a degenerative knee condition which causes his joint to lock and cause severe pain. With little time and lofty goals, Joe turns to an independent physician to help him reclaim his health.

“The best piece of advice I can offer people is to ask one simple question before scheduling a doctor’s appointment,” says Joe. “Not many people even know they should ask this, but it’s important to know if your doctor is independent or employed.” Independent doctors own their own businesses, or are have partnered with other physicians to form private practices with multiple locations. Employed physicians, on the other hand, are salaried personnel who work for consolidated hospital groups. Joe chose independent Orthopedic Surgeon, Dr. Craig Goodhart, with OrthoTexas in Carrolton. “I chose Dr. Goodhart, because I was able to get an appointment right away. I had a few days between jobs and the kids were on a bi-week from baseball. If I couldn’t get in this window of time, I wasn’t going to be able to get my knee taken care of. What I learned during this process was the valuable difference between independent physicians and employed doctors.”

Knowing the difference between independent and employed physicians can empower patients to make more informed choices. As Healthcare Reform pushes higher reimbursement rates to hospitals, private practices across the country are being forced to either close their doors, or be acquired by hospital groups. CNN reported hospital purchases of physician owned practices increased 30 to 40 percent over the past five years, which has made finding an independent practitioner increasingly difficult. However, locating one of these hidden gems not only ensures a higher level of personalized care for the patient, but it also helps heal our broken healthcare system.

The Affordable Care Act was built to incentivize quality of care – not quantity of care, yet according to Paul Ginsburg, PhD, President of the Center for Studying Health System Change, a non-partisan think tank that studies the healthcare industry, “Hospital acquisition of physician practices leads to higher prices.” For example, in May 2013, the Denver Post printed a reported following a patient who received the same cardiac stress test twice from the same cardiologist. The test was first ordered by the patient’s physician as an independent and cost just over $2,000. After the practice was purchased by a local hospital a year later, the second test cost over $8,000. What was the reason for the drastic difference? An added facility fee by the hospital, the newspaper reported. Hospitals have higher operating costs, even if you aren’t utilizing their 24 Hour Ambulatory Care you’re still paying for it in overhead fees. “OrthoTexas is an independent facility, so not only did I get in to see Dr. Goodhart more quickly,” says Joe, “but, I’m only paying for my knee when it’s all said and done. The best way I can explain it, is a la carte pricing; I’m only paying for what I need. And that’s a big difference when it comes to my portion of co-insurance.”

Working in the entertainment and advertising industry, my paychecks are dependent upon the needs of others. So, I can understand why some doctors opt for the security of a hospital job,” Joe says. For numerous independent practitioners, the low insurance payouts are making it so costly to keep their practices afloat, they’re faced with the decision to close the doors, or give their staff an opportunity to keep their jobs, by selling their practice to a hospital group. Giving up self-sufficiency isn’t without its benefits. Administrative stresses virtually disappear. Both physicians and staff are ensured a steady salary, while the hospital takes the added tasks of human resources billing, collecting, overhead, and operations. Doctors assume less on-call time and primarily work on shift-type schedule, freeing up personal time many physicians in private practice rarely enjoy.

But, do the cons outweigh the perceived freedom? Many experts believe so. When doctors aren’t in charge of their practices, many feel patient care takes the first hit. “I want my specialized care to be as personalized as my primary care,” Joe says, “and to an independent doctor, I’m not just a number, I’m ultimately a customer.” Yes, your physician is less constrained by hospital policy and bureaucracy. Many doctors are forced to see substantially more patients per day, decreasing the time spent in each exam. This model inherently works against fostering a solid doctor-patient relationship. “From the moment I walked into OrthoTexas, I was treated like someone who was shopping at a family owned business; I felt like I was in control,” says Joe. “When Dr. Goodhart came into the exam room, he wasn’t rushed. He spent time with me and allowed me to tell him about my concerns and ultimately my goals for the appointment.” And how does hospital shift scheduling affect the patient? It’s manifested as a drastic decrease in the consistency of care. Patients are forced to either see the doctor on call, or wait weeks, even months, to see their chosen provider. In Joe’s case, he was scheduled for surgery the day after his initial consultation at OrthoTexas. “I couldn’t believe it. I was able to meet Dr. Goodhart, get an in house x-ray, and go in for surgery with my same doctor, in a matter of two days. That’s incredible service,” says Joe. This applies to specialized referrals as well. Many independent practitioners will only refer their patients to independent specialists, because the referral process within hospitals is convoluted and their patients experience lengthy wait times. In a June 2012 the Robert Wood Johnson Foundation’s Synthesis Project published a summarization of three dozen studies siting the effects of hospital mergers and hospital acquisition of physician practices on prices, costs, and quality of care. The report was written by Martin Gaynor, PhD, of Carnegie Mellon University, and Robert Town, PhD, of The Wharton School at the University of Pennsylvania. In his findings he established that hospital consolidation generally resulted in higher prices across geographic markets. When hospitals merge in already concentrated markets, the price increase can often exceed 20 percent. Overall, he concluded that physician-hospital consolidation has not led to either improved quality or reduced costs.

Each time a patient chooses an independent physician over a consolidated hospital group, we take one step towards moving healthcare into a patient-centered system. “I would really like to see people shy away from the hospital groups and support private practices. We can’t sit around and wait for government to make decisions for us. Change comes from the decisions we make for ourselves each day,” says Joe. “If we want a system that incentivizes quality care, we need to send a message by first choosing quality care for ourselves.” The independent practice model affords patients a great deal of control over their own health care. Patients can discuss treatment options and outcomes, without their doctor trying to push an agenda. Not having the burden of hospital constraints allows doctors access to a wider variety of treatment options for their patients, as well as the ability to provide consistency of care as their sole provider. “At the end of the day, independent practitioners work for their patients,” Joe explains. This hierarchy advocates an environment rich in customer service and patient satisfaction. It’s a traditional way of thinking, but shockingly rebellious in today’s healthcare system. “Customer service trumps most everything else when I’m paying for any type of service. I’m a firm believer in independent doctors and would recommend them as a first call, not as a second opinion.”

Complete Orthopedic Care.

Completely Patient Focused.

To Schedule and appointment, please visit

  • Total body orthopedic care 28 fellowship trained, board certified orthopedic physicians
  • All major insurances accepted
  • Physician owned
  • 9 state of the art facilities with onsite surgery, imaging and physical therapy
  • Affiliated with all major hospital groups

Living Well Magazine Spring