Private practice 3.0
Many doctors will be finishing their residencies and fellowships this June and, by now, most have decided whether to go into private practice or become an academic or non-academic employed physician. There has been a lot of talk about the rising number of employed doctors, the pros and cons of each situation, the risks and benefits and the future of private practice. Even Congress is concerned. Many are concerned that MACRA is another nail in the small medicine coffin.
Most agree that 1) the numbers of employed physicians are rising and that 2) most graduates say they are electing to be employed doctors because they don't want to deal with the administrative and business complexities of private practice. They also want more work-life balance and a guaranteed income. It seems to me the decision is about whether someone has an entrepreneurial mindset and the knowledge, skills, and attitudes it takes to be successful as an independent medical business professional or not.
However, I believe a lot of employed physicians would opt for private independent practice if there were a viable, safer option than what exists now. The new private practice would:
1. Provide turnkey practice management and administrative support
2. Provide ancillary services to address potential physician burnout and restore joy to the practice of medicine.
3. Offer flexible options renting space. Like the commercial says, why pay for minutes you don't use?
4. Offer job sharing options.
5. Use a business model that offers the requisite, reasonable income commensurate with productivity. Cash-based services and service line extensions will be part of the mix.
6. Provide state of the art health information systems that capitalize on the promise of value-based care, including population health, analytics, and bundled reimbursement.
7. Deliver the participant experience, not just the patient experience
8. Use economies of scale to lower the costs of lab, imaging, and other office-based testing.
9. Use digital health technologies to deliver new care delivery models that supplement face to face care that reduces unnecessary visits and waste.
10. Lowers the overall cost of practice.
11. Make career strategy bootcamp mandatory for medical students and residents
12. Create mentorship programs.
It used to be the 3As of private practice success were ability affability, and availability. Now you need to add affordability and online accessibility. The 3As of employed practice are feeling appreciated, having opportunities for career advancement, and attention to the physician experience.
Private practice primary care models have evolved from 1) gatekeeper, 2) direct primary care, 3) risk taking/value-based care, and) consolidated practice models
Many forces threaten the growth in employed physicians and doctors need to reconsider the attractiveness of independent medical practice. Consolidation of hospitals to grow market power and create economies of scale is but one.
Residents, fellows, and others struggling in private practice are choosing to be employees because, for a sizeable number, they see no other port in the storm. When the model of private practice changes, however, and it rapidly is, the resignations will start flowing and we'll see a bump in the numbers of private practitioners once again. Then they will be practicing Othercare.
Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack