The Decline of the Independent Practitioner

Much of the health care system is in a state of flux with hospitals and practices of all sizes merging into larger organizations.  With profits dwindling, many hospitals and medical groups have devoted available financial resources to acquiring greater market share.  This drive to consolidate has squeezed out many of the smaller players in the industry, including many private practices. In a recent study of 20,000 physicians by the Physicians Foundation, only 35 percent considered themselves independent, compared to 49 percent in 2012 and 62 percent in 2008. The Lure of Locum Tenens As more doctors leave behind their private practices, they are taking on new provider roles. One role that has grown significantly in popularity and is reshaping the health care industry is that of the locum tenens physicians.  These physicians are lured by the short term commitment, high level of compensation and diminished responsibilities.  According to a recent study, about 6 or 7 percent of physicians in the U.S. would label themselves as full time locum tenens doctors, but this is likely to grow to 11 percent within the next two years. One of the major contributing causes is the growing number of young doctors who take on locum tenens assignments immediately after completing their training. A recent survey found that 21 percent of young doctors enter the work force via temporary assignments, up from 16 percent in 2013 and 14 percent in 2012. Other locum tenens professionals are entering this role after selling their practice and filling temporary placements during a quasi-retirement. Security in Employment Many other newly minted physicians are taking the route of greater financial security—employment with a large health care organization. Physicians who complete their education and residency training today often have much larger debts than their colleagues in years past, and they recognize the risks in establishing a small business in the evolving health care system.  They watch many more established practices flounder or get gobbled up by competitors, and are unwilling to take on such enormous risks with their already considerable debt load. The majority of physicians are presently in employee positions; almost 60 percent of primary care physicians and half of surgeons work for hospitals.  Many of these medical professionals are finding employment more amenable to their life situations.  As employees, they can make time for family and non-professional activities more easily than if they were self-employed.  Physicians are also more free to take on high risk cases, because the organization is shouldering the greater part of the risk. Provider Alternatives In an effort to mitigate risks and share costs, many physicians are structuring new types of large practices.  One of the most innovative is the medical home, in which a physician heads a team of diverse medical professionals that work synergistically to alleviate physician burnout, decrease costs and improve outcomes. Typically, a group of independent practice pool personnel and resources to eliminate unnecessary redundancy and acquire key technological products.  There is almost always promotion or hiring of key managers to streamline operations. Another popular strategy for care providers is to set up concierge practices. According to the Survey of Physicians and Health Reform, almost 16 percent of physician respondents were planning to begin a concierge practice in one to three years. The primary advantage of concierge practices is the ability to focus on a limited number of patients, optimizing outcome and limiting the usually high administrative costs of running a practice. Many concierge practices treat only patients who pay out-of-pocket, thereby eliminating the costly act of seeking reimbursements.

Written by:  Robert Moghim, M.D., CEO- Moghim Medical Consulting Inc.

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