C When Dr. Lawrence Gordon opens his family medical practice next month in Mount Airy, he plans to spend most of his time with patients instead of struggling to keep up with insurance paperwork and billing.
He'll leave most of the business of medicine to Carroll County General Hospital.
The hospital owns Dr. Gordon's practice and will pay his salary, take care of billing, hire staff and handle other administrative tasks.
Dr. Gordon comes to Mount Airy after five years of running a solo practice in Collinsville, Va.
"You start losing the ability to spend time with your patients; 30 to 40 percent of your day is spent on paperwork," said Dr. Gordon, 38. "Now the hospital will worry about paperwork and I can worry about practicing medicine."
Similar arrangements are becoming more common as hospitals establish relationships with physicians to secure patient referrals, compete for managed care business and provide medical care in underserved areas.
"There are lots of networks and partnership arrangements being announced from week to week," said Nancy Fiedler, a spokeswoman with the Maryland Hospital Association. "The health networks of the future require an increasingly close relationship between doctors and hospitals."
This may involve hospital ownership of practices, shared ownership by doctors and hospitals or hospitals providing management support to medical practices.
"Doctors have got to deal with all the intricacies of contracting and negotiating with big powerful payers [HMOs and insurance companies]. It's nice for them to be able to lean on a larger network," said Michele Deverich, a vice president at Johns Hopkins HealthCare, which provides support services to physicians associated with Johns Hopkins Hospital and contracts with managed care organizations.
Partnerships with hospitals are frequently attractive to young doctors not prepared to deal with the expense, paperwork and long hours associated with opening a solo medical practice.
"We felt that it would be one strategy to help us build up a primary care network we might need to contract with managed care companies," said Linda Harder, Carroll County General's vice president for marketing.
Managed care companies -- primarily health maintenance organizations -- pay health care providers a set fee per month for each patient they treat. These companies are looking for easier and cheaper ways to contract health care for groups of people.
"Primary care physicians are very desirable to have as part of any health care network you put together, because they act as gatekeepers" to other health care providers, Ms. Harder said.
The hospital-owned medical practice model has been working well for Dr. Anthony Amabile, who has been running a practice owned and managed by Kent and Queen Anne's Hospital in Chestertown the past five months.
The arrangement was attractive to both parties. The hospital had been trying to recruit another primary care physician to serve its patients, and Dr. Amabile wanted a solo practice in a small town.
"I didn't feel comfortable dealing with the nightmare jungle that is managed care and trying to practice medicine at the same time," said Dr. Amabile, 33, who practices in Millington, a small town 15 miles east of Chestertown.
"I wanted to have a practice where I was respected and a part of the community, and that's what I found here," he said.
Carroll County General has entered into arrangements with two other doctors who will be employed by the hospital in private solo practices.
Dr. Julian Choe, an internist who just completed his residency, recently took over the Eldersburg practice of Dr. Arthur Lomant. The hospital bought the practice after Dr. Lomant moved to Georgia.
Dr. Sharon Alongi will run a hospital-owned family practice at a location that is still to be determined.
By establishing hospital-owned private practices, Carroll County General hopes to fend off competition from other hospitals for local patients and meet a need for more primary care physicians in the county.
The hospital plans to locate its practices in areas not already served by doctors affiliated with Carroll County General.
"We want to make sure that another hospital doesn't come in and put in primary care physicians that send patients outside the county," Ms. Harder said.
"It's a competitive environment and a lot of people look at Carroll County as a growing area and an attractive place to capture a patient population."
The financial security of a hospital-owned practice appeals to younger doctors, many of whom have a mortgage and a family, as well as large medical school debts.
"The employment arrangement allows us to bring in certain physicians that might not come into the community otherwise," Ms. Harder said.
Carroll County General will lease the physicians' office space, hire the staff, purchase office equipment, handle billing and set up information systems.
"It used to be that the business end of running a medical practice was minimal," Dr. Gordon said. "Now, it's really like running a small business, and none of us went to medical school for that."
Although Carroll County General will be his employer, Dr. Gordon said he will have authority over his practice when it comes to medical care.
"I've been given full autonomy on how I treat my patients," he said. "I plan to run this practice the way I ran my other practice."