Hospitals go to great lengths to drive out independent doctors from their medical staffs, a new editorial in the spring issue of the Journal of American Physicians and Surgeons reports.

Dr. Lawrence Huntoon, a neurologist who has a "third-party-free" practice in upstate New York, writes that as the number of hospital-employed doctors grows, so does hospital control of physicians and the abuses inflicted on independent doctors to make it harder for them to practice in the hospital.

Hospitals gain revenue from employing physicians in several ways, he notes. These include excessive testing by hospital-owned facilities and "churning specialist referrals."

In addition, hospitals are experts at gaming the Medicare payment system. To achieve total control, hospitals have many techniques for "purging" the few remaining independent physicians from the staff, which include:

• Sham peer review--bringing unfounded accusations against which doctors have no chance to defend themselves;
• Creating a hostile work environment, with constant bureaucratic demands.
• Restricting their operating-room time or shifting referrals to employed physicians.

"Hospitals should not function like hotels where the overriding goal is to fill beds so as to maximize profits," he concludes. "Physicians employed by hospitals who are paid a monthly stipend for being loyal to the hospital should not function as salesmen to fill hospital beds."

Dr. Huntoon is editor-in-chief of the Journal of American Physicians and Surgeons. You may read his full editorial here. You may reach him at (716) 627-7759, or editor@jpands.org.