Executives at Baptist and Holy Cross say the physicians’ practices on their own do not break even after being purchased, but ancillary income from such measures as diagnostic tests boost the bottom line. The recent hiring of physicians hasn’t worked everywhere. The community doctors hired in the past several years by Jackson Health System, Miami-Dade’s public hospitals, have been persistent money losers. The unaudited financial statements for fiscal 2011 show that the doctors’ practices lost $4.4 million.

“We have done a bad job of acquiring and managing doctors’ practices,” says Carlos Migoya, who became chief executive May 1. He has not hired any doctors since taking over and won’t “until we fix what we currently have.”

Kenneth Homer, an Oakland Park internist who had been in private practice for 20 years, says it made sense three years ago for him and three partners to work for Holy Cross. “We can take better care of our patients,” he says, because he doesn’t have to spend time dealing with all the business aspects of a private practice.

Juan-Carlos Verdeja, a general surgeon for two decades, says he was “very resistant for many, many years” about working for a hospital, but last summer he and four partners joined Baptist because he saw that American healthcare was moving toward integrated services, meaning small groups of doctors would have a hard time surviving on their own.

Verdeja doesn’t believe doctors in the 1990s headed to golf courses when hospitals started paying their salaries. “Most physicians are dedicated individuals who take their professions very seriously,” but he acknowledges that hospital management didn’t do a good job in the 1990s of supervising them.

Not all doctors are convinced. Bernd Wollschlaeger, a family practice physician in North Miami Beach and former head of the Dade County Medical Association, says he’s happy to keep working on his own. He’s preparing for the future by applying for certification as a “medical home,” a concept of coordinating care that is central to reform efforts.

“Some doctors get a false sense of security,” Wollschlaeger says. He points out that hospitals are facing their own challenges in the years ahead, with major cuts proposed in Medicaid and Medicare compensation. “You get a paycheck and you think everything is hunky-dory. But it may not end up that way.”