When in doubt, the answer is money. It's very difficult to maintain a small practice. Insurers make that even more complicated so they are forced to see our to larger groups.

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One word, MONEY. Seriously my former family doctor closed his practice to work at one of these facilities. When I asked him why he told me they were after him fir a while and he made them an offer he thought they would refuse, they accepted. He said he now makes 3 times the money he used to make. If a patient didn't have insurance he would charge 85 for the visit and if you had insurance he would bill 250 to the insurance company and they paid him 85 but the insured wasn't responsible for the difference. Being I had insurance but a high deductible (pre ACA law) I always paid out of pocket. When I went to the new place where he was at I was going to pay cash and he said not to do that as it would cost me 150.00 so I put it through my insurance.

One time on FB I seen someone posted a message looking for a new doctor as her doctor went to one of those medical facilities and she would wait longer than she would when he had his own practice. I private messaged her and asked her if her doctor was the name of the doctor that I seen and she replied back it was. We both had him and were fed up with the service provided at the new facility. It was even at one point I set a timer when he came into the exam room. He asked why and I told him the bill seems to be higher when I am in here longer and at the other place you never charged more if it took longer. He wasn't happy with my response. I think he probably lost a lot of patients because of the move. The last I heard is he relocated to Tennessee.

I’m in billing and this is exactly it

Let’s see, the doctors have less time to see the patients and malpractice rates are going up, see a correlation?

Your government just voted in a Medicare reimbursement cut after 3 years of doctors giving it their all.

Coming from NYC I don’t see the problem

Really annoying having to make an appointment at different offices and then tests and whatever instead of all in one place

They do the blood work in house at their own lab which may not be covered by your insurance. But they don’t care. They won’t sent it out to the lab your insurance covered. If they can run the test in house, they will. But the cost will almost be 30% more than major labs.

I'll give you the other side of the coin. My husband is IM in Pittsburgh as a hospitalist because he got residency in Youngstown. First screw the tristate for not considering giving preference for their own unlike the rest of the county. My husband ranked both FM/IM in CT, NY, NJ and he did rotations in all those programs but one.

Youngstown was next on the list after that. He gets to Youngstown and tells them he's staying local since I moved to Pittsburgh 8 months into residency. They gave him the shittiest outpatient rotations and gave Ohioans the good ones. Most of them specialized or didn't stay in the area.

So he pisses off his program by not staying on for outpatient after finishing residency. That residency program killed his dream of opening a practice early on. Now he's a hospitalist, makes good money, we have LCOL, loans will get paid off, WLB and doesn't take work home.

All of the PCP practices are closing and the hospitalists' workloads are increasing because those old PCP rounded on their patients at the hospital. No one wants to take over their practices, it's not worth it.

Now we are living here until the loans are paid off, we don't need early intervention since NJ has an income cap unlike PA, and our kids are out of public preschool. When we move back I fully doubt my husband switch to PCP. Our trajectory changed so drastically by matching in the Midwest.

because it's what makes financial sense for doctors. overhead for running your own practice is out of control and insurance payouts are slimmer than they used to be. being a salaried doctor for a major practice and just doing doctor stuff and having someone else there that deals with the insurance payments and all that jazz is a way better deal for almost every doctor. plus changes made under the aca have encouraged this along with all the hospital consolidation. this is why almost every doctor is now a part of summit health, atlantic health, rwjbh physicians practice, hackensack meridian health, or optum (i'm hesitant to include cooper in this because i can't tell if they have a network of doctor offices in addition to the hospitals, but it would not surprise me if norcross has his hands in this sector as well).

btw, this isn't just a new jersey thing. this is happening all across the nation, for the same reasons. we're actually an outlier in that we have multiple system options. many parts of the country have but one option that you're stuck with whether you like it or not.

further, if you're getting a bill from a doctor's office that doesn't match up with what your insurance was billed, that's insurance fraud and incredibly illegal. don't just sigh and pay it. report it. don't let it just go by the wayside.

idk, my doctors are part of summit health and whenever i need to make appointment for bloodwork, the first thing they ask me is "what lab do you use" so i could easily direct them to the lab that will cover my labwork (as it turns out my insurance pays for their internal lab just fine).

I’ve seen the good and the bad when it comes to large medical practices and agree I don’t see a problem if they do it well. The more convenient and accessible healthcare is, the more likely people are to seek it out before things get too bad.

Hackensack Meridian is a joke - the providers we’ve seen there have been awful and the “portal” is non-existent. Customer service has also been lacking when I’ve complained.

I’ve certainly had my issues with Summit Health over the years but I’ve never doubted the care I get through them. If an issue comes up where I need a specialist, they’ve connected me directly to their offices and I don’t lift a finger til they call to make an appointment. I can also make appointments and ask questions thru the portal and get doctor’s notes online.

Ask yourself why are (animal) vets doing the same thing?

Have you used Hackensack meridian recently? I use them for prenatal care and I love it. To be fair though, I haven’t been there for anything else so now I’m curious about how other specialties are

Also a doctor and very familiar with billing. The entire managed care/commercial insurance driven reality focuses so much on efficiency that GPs are forced to adapted. There is a HUGE shortage of young GPs in the USA.

Here’s an example from psychology. Years ago, only psychiatrists conducted therapy and also prescribed medicine. Then psychologists became a credential profession to do just the therapy part (didn’t need to ALSO be a physician for the medicine rx). Then counselors came along and could do the therapy part without having to learn psych testing and evaluations. Now there are psycho-metricians that can administer tests and psychologists only INTERPRET the results. Basically insurances want clinicians to ONLY do the part of their job that requires the highest level of training. Anything under that is done by a lesser credentialed clinician. And it saves insurances tons of money that isn’t passed on to customers.

Did you know that in 2020, during a pandemic, Indep Blue Cross had its highest profit year EVER!?!? Think about THAT one….

In the medical field, we see the addition of Physicians Assistants (to be called Associates starting next week) and NP’s. Unfortunately I see this trend continuing….

The worst part of this trend is that if that large cooperate group doesn’t take your insurance, suddenly you can’t see dozens of doctors for all different specialties. It’s horrible

I talk to the same Irish lass no matter what I’m calling about when I’m reaching my GP. My doctor is affiliated with Hackensack Meridian. Because of my specific shitty conditions I end up exceeding our out of pocket very early, so I generally bypass my GP early on.

She’s very nice. She usually just passes me on to the nurse in office very quickly. I’ve grown fond of her.

I will say my pediatrician for my kids is AMAZING and I’ve never waited at all to get them seen if necessary. Nor have I waited on hold longer than five minutes ever, and it’s been years we have used them.

We tried an OBGYN and a primary care doc. So not the hospital itself but they have all these providers in their network. I thought that would mean something for the quality of care but both providers were terrible at patient care and office management - like you’d call one and lines were forwarded to the doc’s personal cell, which was never answered, or the office would be closed when you had an appointment and no one bothered to call in advance to reschedule. Patient care itself was unacceptable - test results wouldn’t go up on the portal and bedside manner was completely inappropriate.

Blue cross is such trash. They dropped our coverage numerous times over 3 years because we had automatic pay set up. And paid on time. Then at a dentist or dr appt being told “you have no coverage and have to pay in full.” Or a medical emergency with my 4yr old where she had to be hospitalized for 3 days. Hospital actively trying to kick us out cause we had no insurance and my husband fighting for 3 days with BCBS to reinstate our benefits. And the hospital staff shaking there heads saying “yeah this happens all the time..”

It boils my blood I’m not an isolated incident. That so many like me are paying astronomical amounts for health insurance, only to have all benefits stripped away the second we go to use them. Punished for paying in time or early. Make it make sense

I was married to a doctor for 10 years. My experience was that doctors are just rich people in the US cosplaying as hero’s. The amount of money and support one needs to become a doctor sort of weeds out anyone who is doing it to help people.

I’m a patient there as well. Same thing, I’m asked which lab I use. Actually I like being a patient there. the ease that doctors can share data etc

what year was this? What state was your coverage based??

regulation for this has improved over the past few years. specifically 2010 ACA and 2011 parity law made some huge improvements (pre-existing conditions, mandatory coverage for various services like mental health, catastrophic coverages, etc), its such a shame SOME (not mentioning names to make this political) politicians did their best to tear those laws down. If they just worked to IMPROVE instead of REMOVE we really could have been close to having a system that works.

An existing problem that still exists is that insurance is regulated state by state. I live in NJ and the same plan from Horizon BCBS costing $700/month for a couple (2500 deductible, $20/$50 copays) costs $1500 in Delaware with Highmark BCBS because of the difference in income-driven costs. We all know the best way to keep premiums down is to enlarge the pool of customers. One way the insurances ruin that strategy is to hack us into groups (not allowing cross-state plans).

While I see myself as socially liberal, the Democrats' incompetence has cost us progress as well. However finally allowing CMS to negotiate drug prices for Medicare/Medicaid should be a big improvement for some older and poorer folks.....or maybe Im being naive and the crooked PBM and insurance companies will find a way to sidestep that too....

Sorry, I can go on all day about this shit. drives me crazy.....

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Edit: another rant: another thing people dont realize is their employer HR manager negotiates with insurance brokers for your plan. If you work for a company (especially smaller companies) with older employees op high-utilization folks (read: sicker), it WILL affect the cost of YOUR premiums. Working for a larger, younger company equals lower premiums.

It’s based in NJ and has been consistently an issue since 2020

obviously I dont know your issue, but there's something odd going on here. The only way a company can legally "drop" a customer mid-year (not during open enrollment ie. end of the benefit year) is bc of not paying the premium. Even then, there's a grace period where if a person catches up on premiums it's as if no lapse in coverage occurred. They also MUST send out letters stating premiums are behind and provide a deadline date.

At my practice we get these letters all the time. like, weekly. Patient A has been coming in and we receive a letter stating "Patient A hasn't paid their premium, if its not paid by Date X claims from (date to date) won't be paid."

Please dont read this as not believing you, what im saying is knowing the regs a little bit gives you some leverage so you aren't surprised as you mentioned. There are also programs to cover kids, even if you have reasonable financial means (CHIP), and it's backdated. So if your kid didn't have coverage starting Feb 1 and he/she I admitted into hospital Feb 15, CHIP will cover the costs 90 days PRIOR to claim. Most hospitals have a social worker that will help with application. Now, its a low-paying plan and they will still try and get you out quickly (hospital soperate in the red with CMS rates and need commercial plans to stay afloat), but you won't be on the hook for monster bills.

https://www.insurekidsnow.gov/coverage/nj/index.html

Report to whom? I’ve had many fraudulent billings from Atlantic Health over the years and have never been able to find assistance.

I’m a physician in New Jersey. They are being bought out by corporations. The problem is if you try to resist, you’ll get boxed out and made miserable by the corporate healthcare entity you snubbed. They buy up referral bases and work with insurances to get their physicians in network and everyone else kicked off. 99% of doctors want their own autonomy and control of their practice but it’s undergoing a hostile take over right before our eyes.

Same here, and my dr., although in a small satellite office, not one of the main ones, does have a small lab right there. It's literally a mile from me, and very convenient. I also have numerous docs within SH and knock on wood, have not had any issues, other than sometimes having to wait a bit to get in to see one.

Its convenient as well when I need my every 5 years endocsopy; i have it done at their same day facility, and because they have it all there everything, including the anesthesia and pathology, is covered as they are in my net work. Prior to that, if i had it a one of the local hospitals, anesthesia and path were not in network and I got hit with some large bills.

Arg… yeah… the summit medical group is consuming all my doctors…

Just like in every form of business nowadays, whether it be food, services, goods, etc., small businesses are being consumed by large corporations. Health Insurance companies in the USA are a joke and they get to make their own rules because they’re in the pockets of every politician.

Before the doctors join larger medical groups they are also very much for profit. It’s not the group that introduces the physicians to a for profit model they just make it easier for the doctor to practice medicine and not focus on the business side of things.

Nun and ground breaking chair of the American Hospital Association, Sister Irene Kraus, famously said it best “no margin, no mission”.

I’m a healthcare M&A attorney. It’s all about money. They get better reimbursement in the larger setting and they can also sell out to private equity for a massive payout.

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This is the correct answer. Large physician groups receive better compensation from insurance companies. The rationale is that physicians within that group will refer to other physicians in the same group and the end result will be better continuity of care, therefore lowering healthcare costs overall. For example, if your Summit Health primary care physician refers you to a gastroenterologist who also works for Summit Health, Summit profits from the services provided by both doctors. If they refer to someone outside of their system, the practice they refer to collects. The continuity of care piece comes in that health records are seamlessly accessible to all providers. This also allows Summit to monitor the “appropriateness of care. Used to be if Dr. A was friends with Dr. B, she might refer patients to Dr. B for bullshit, unnecessary testing or consultation. Dr B becomes wealthier as a result. Bottom line…it’s not going away.

Interesting, my experience is the opposite! There are so many easier ways to make money than investing four years in undergrad, four in med school, three in residency working 80+ hour weeks, +/- a fellowship after. Ya gotta REALLY be dedicated to go through all that.

They want to make more money while providing less service. And that is what they are doing.

> Did you know that in 2020, during a pandemic, Indep Blue Cross had its highest profit year EVER!?!? Think about THAT one….

3.4% “profit” margin in 2021, 2.9% in 2020, 2.1% in 2018. And not really a profit margin since Independence Blue Cross is a not-for-profit so there are no owners to distribute profits to.

https://www.ibx.com/about-us/annual-reports

Managed care organizations (aka health insurance companies) have tiny profit margins in general. UHC has 6%, as an outlier, but the rest, Elevance, CVS, Cigna, Humana, Centene, Molina, etc all have 2% to 4% profit margins, year after year for a decade +.

Not really much juice left to squeeze there. The bigger profit margins are in pharmaceuticals, software vendors, equipment vendors, and doctor groups (which PE firms had noticed 10+ years ago).

> I live in NJ and the same plan from Horizon BCBS costing $700/month for a couple (2500 deductible, $20/$50 copays) costs $1500 in Delaware with Highmark BCBS because of the difference in income-driven costs.

What are income-driven costs? I have not seen differences that big between states.

https://www.kff.org/health-reform/state-indicator/average-marketplace-premiums-by-metal-tier/

> We all know the best way to keep premiums down is to enlarge the pool of customers. One way the insurances ruin that strategy is to hack us into groups (not allowing cross-state plans).

This was not because of “the insurances” by the way, this was upper middle class and pretend upper middle class people that forced this issue. White collar workers that worked for well funded and established businesses balked at their insurance premiums going up to pay for poor and unhealthy people.

People are, unfortunately, very tribal.

That is really awful, I’m so sorry! It’s sucks that finding a doctor is really hit or miss. I didn’t have a super great experience in the ER in terms of bedside manner, but office visits always go well. I hope you were able to find a practice somewhere that treats you well!

When we were in the hospital absolutely no one there was willing to work with us or discuss other options. No one even mentioned CHIP to us. We had NJ family care years ago but since priced out of it basically.

We again had auto pay set up and paid our premiums. We’ve had to pay hundreds and thousands out of pocket and certain appointments after finding out we’d lost insurance.

It’s been hell. And the worst part is, it isn’t just us. We’ve multiple self employed friends using BCBS, set up for autopay and same thing. Punished for paying on time and coverage is dropped. There was even a huge lawsuit circulating for people to sue horizon because it’s been getting so bad.

Most "marketplace" plans take into account income to determine how much insurance plans are subsidized. Each state determines their own scale. In NJ and DE, the scales are significantly inconsistent with one another. These numbers are made up, but just for illustrative purposes, a person making 100k in NJ may qualify for 25% subsidies while that same 100K qualifies for 5% subsidy in DE.

And to your other point about this being class driven, I have no doubt there was that type of mentality in there, sure. BUT it wouldn't have actually happened if it didn't benefit the insurance company. and it wouldn't have been ALLOWED to happen if legislatures had the good of all people in mind.

We have a mentality that in the USA that people who are poor and underserved are deservedly so, and that it is their own fault for being in that position in the first place. I can point to several social perspectives that boil down to that single factor. Its situation vs disposition phenomena at its finest.

It's terrible. My PMD's new office policy does not allow visits if you are sick and don't have an appointment, they send you to urgent care. I don't mean emergency visits, just "I'm really sick and need to see my PMD" visits. Worked out real well when my kids and wife got severely ill. Thanks Atlantic Health.

as a business owner, I understand the importance of margins, but that marginal increase translates to them profiting 2.6BILLION dollars more than the previous year. My real point being this was during a pandemic. Sure, during typical years a 2-4% increase is a sign of good, lean management. but it's the same way flood insurance companies make more money during floods....it sure seems counter intuitive, no?

and keep in mind that increase also included the "cost sharing" programs where all copays were waived because they were making so much damn money apparently they felt guilty or were just concerned about blow back. I haven't seen any published figures about what they "waived" but Im willing to bet it'd bump that 2.6B up a bit if they weren't on the hook for it.....

https://news.ibx.com/independence-health-group-reports-2020-financial-results/

maybe im just cynical because I see it from clients perspective and see so many people struggling to access care to sustain a basic quality of life I believe in this country should be an inherent right. I dont believe healthcare should be attached to employment, and I do NOT believe in single-payer solution. (government OPTION.....maybe.)

also, regarding the "average" chart, have you seen a chart showing MEDIAN? this is clearly a situation of restricted range with some folks paying very little and some folks paying the higher end. sure the average may be $400, but that doesn't illustrate the difference between person 1 paying $10/month and person 2 paying $800.

> as a business owner, I understand the importance of margins, but that marginal increase translates to them profiting 2.6BILLION dollars more than the previous year.

Nominal profits are not comparable year to year, especially due to the decreasing purchasing power of the currency, aka inflation. Hence, it is most appropriate to use profit margins when comparing a business’s performance over time.

> Sure, during typical years a 2-4% increase is a sign of good, lean management. but it's the same way flood insurance companies make more money during floods....it sure seems counter intuitive, no?

Health insurance companies are kind of / not really insurance companies, which is why I think managed care organizations is a better term for them.

Just reading the report I linked.

"Independence Health Group, Inc., (Independence) the parent company of Independence Blue Cross, LLC, reported solid financial results for 2020 with total revenue of $21.8 billion, up $2.6 billion or 13.5 percent over 2019"

you could argue the same for profit margins too. If you want to get into depreciation, cash on hand, deferred losses, bad debt, real estate depreciation/appreciaiton. then those numbers Never mean anything at all. you're still getting lost in the numbers and missing my ACTUAL initial point. what you're saying is valid, but I believe your missing the forest for the trees here. good day, good luck. im out.

> And to your other point about this being class driven, I have no doubt there was that type of mentality in there, sure. BUT it wouldn't have actually happened if it didn't benefit the insurance company. and it wouldn't have been ALLOWED to happen if legislatures had the good of all people in mind.

Possibly, health insurance companies are going to benefit regardless if everyone was required to purchase health insurance. Theoretically, it makes no difference to them if an employer is involved.

I just specifically remember people up in arms about removing employers from the equation and being dumped onto healthcare.gov where the risk pool would have caused them to pay more.

People are still upset at health insurance costing more than pre ACA, even though it covers a lot more (no benefit maximum, no denial due to pre existing condition, no underwriting for one’s specific health risks, etc.).

And of course, the fake religious “insurance” that is not really insurance or complaint with ACA had to be allowed, and that was not due to insurance companies.

https://www.fbi.gov/how-we-can-help-you/safety-resources/scams-and-safety/common-scams-and-crimes/health-care-fraud

https://www.nj.gov/oag/law/al.htm

It’s not as difficult as you make it out to be. Most of them come from family with money and have extra curricular activities and internships arranged for them. They go to undergrad just like everyone else. Medical school is set up to be as accommodating as possible as so almost no one fails out. You don’t even have to show up to lectures you can pay to have receive transcripts from each class and just show up to the tests.

Yes it takes a lot of work but most people with a graduate degree have put in the same work but their degree doesn’t get compensated as much because their careers aren’t protected like doctors. If you come from another country you have to get into a residency/fellowship program first here in the states unlike say a computer engineer that can easily obtain a job here in the states with their foreign degrees.

Again, my experience is that about 95% of doctors would never have become one of it weren’t for the unwritten promise of being in the elite crowd and going to dinners and wearing fancy clothes.

My kids pediatrician was an independent practice for a long time. What finally drive them to join one of the major groups (summit medial) was the cost of switching to electronic medical records, which was being mandated.

Now they aren’t allowed to refer to any specialists outside Summit Medical which is super annoying.

start with your insurance company. if they're sending your insurance one set of codes and then a bill to you for different ones, that's proof of fraud right there. your insurance company is going to take swift action to make sure they're not paying more out to the doctor than they're supposed to. compare the explanation of benefits you get to the bill you get, and if things are different, that's your proof.

otherwise, contact dobi which is the arm of state government that deals with this sort of thing.

My doctor recently joined one of the large medical groups and he even said beforehand that it was financial resources. The large groups allow them access to resources and equipment they may not have outside the system.

Doctors just want to practice medicine. They don't want to have to worry about medical coding, billing, IT, and the other administrative functions that can be prohibitively expensive to hire people for.

They join MD groups because all of that is taken care of for them.

My doctor told me he's struggling to keep his practice. And he's the best doctor.

I’m lucky in finding an endocrinologist that hasn’t linked into a hospital group. Finding a freestanding PCP is impossible 😩

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My dumbass was trying to figure out how bring from Billings Montana made you an expert

My doctor used to be great until he joined a big group. Was able to see him regularly and actually talk to him about issues. But now if something comes up I need to go to a walk-in clinic because he’s to busy to see me. And even when I do see him the 2 or 3 times a year it’s all business like. No more talking to see how I’m really doing. You wait 2 hours in the waiting room for 10 minutes of his time. Sucks because he’s really good doctor. Or was a really good doctor.

> And it saves insurances tons of money that isn’t passed on to customers.

The ACA requires insurance companies to spend 80% of premiums on benefits, so effectively any cost savings have to be passed on to customers. Customers won't see that in the form of a cost reduction because all they're really doing is slowing the rate of healthcare cost inflation. But that still saves the customer money compared to the status quo.

Same reason most mom and pop stores disappeared: money and power. Big insurance companies/medical groups are the Walmart of health care.

sure. but there's also a thing called "creative accounting." that ACA rule also allows for deferments and other "deduction" type loopholes. I think its a good thing, but its not as simple as calculating ACTUAL revenue * .8

There are SO many things broken about our system. what upsets me is that we could fix them but we CHOOSE not to. See above posts about judging who "deserves" quality care.

Health insurance is a country is a fucking disaster. Let’s just start at that. It is insane that we cannot get politicians who will come in and fix this disaster. Republicans have absolutely NO solution for this problem and democrats barely know what they are doing.

This is what happens when you have politicians running a county. We need to get money the fuck out of politics.

I pray for a day we see proper healthcare reform

from there as well. its due to lack of competition. some things shouldn't be competitive.

Medicare is federal and states have nothing to do with Medicare reimbursement.

Medicaid is under state jurisdiction.

The doctors going to fine dining and wearing fancy clothes are in specialties that do not accept insurance or in discretionary medical services (i.e. cosmetic/plastic surgery, dermatology, cosmetic dentistry) Ones in primary care live like any other middle/upper middle income folks.

Doctors trained in foreign countries being required to go through residency/fellowship in the US is not a bad thing. It establishes an expected minimal level care, normalizes the standard of treatment as well as provides foreign trained doctors plenty of supervised training dealing with illnesses seen in the host country. This way, a doctor trained in Vanuatu, Palau or Switzerland can provide you with the same level of care as ones trained in the US.

I mean we can start the efforts to phoning our state senators and legislators on mandating safer staffing and such. Understaffing a unit can harm patients yet hospitals continue to do it. Because healthcare is moving MORE towards profit driven model, even non profit, not further away.

Doctor shortage is something that's gonna exist no matter what in the modern world. That's why all this move towards delegating what tasks can be delegated is being done.

Yup. Now that I'm on Medicare, I could go to any one of the great Boston hospitals if I needed serious surgery or something. NYC has a good reimbursement rate, so I could go there too.

I mean you really only described one of many of the shittier caricatures/stereotypes of doctors so I'm gonna venture and guess you were surrounded by the numbers doc/the ones who audit their own practice and timed each second as valuable because time is money rather than time can save lives.

Yeah there are these kinds of doctors around. There are nurses like this around. There's plenty of great doctors out there who are just normal people. Maybe because doctors are just normal people, not heroes. Healthcare workers are normal people.

Half the times, I see people talk down on doctors and such, it's always based on an idea of a person representing the entire profession for them. Or people judge people worse for not living up to the expectation that they're heroes.

Seems to be a common thing on social media these days for example to call nurses mean girls and think bullies end up nurses and nursing is to girls what cops are to men. Like where are all these asshole docs and bully nurses? I work in patient care. As far as I can tell, more than half the times patients or their families are nasty af and staff just trying to remain calm while taking abuse.

You think that politicians can legislate whether a doctor can join a practice or consolidate with other doctors?

Hackensack Meridian for me

No but they can mandate a hospital to signing on out of network docs from a practice or medical group properly so it gives them more time to see patients or perform their work without as time crunching pressure. Also it's not doctors really doing patient care. In those cases, docs will at most see you for 15-30 minutes. Nurses are doing all the patient care and they're understaffed to all hell and the best way they're getting help is from techs and aides who aren't getting paid enough for what they go through. Why put up with all the bs of patient care when Walmart is paying the same

it’s not just in NJ, huge health systems are everywhere. state of the art buildings doesn’t mean good care.

This is as true as it gets. And they will continue to put pressure on “efficiencies” which means less face time with a doctor who will essentially “sign off” on a procedure/eval/assessment while the nurses handle the actual administration of the procedure and the support staff handled the logistics.

On paper, it’s not a bad idea (the efficiency model not the corporations buying up local practices). But a model that runs on efficiency equates to a need for high volume. And high volume leads to corners being cut, mistakes being made, and a worse patient experience. But hey, we can brag we’ve got the most “efficient” hospitals in the world!!! We got that going for us….and that’s kinda nice….