You can always start your own practice,” is something I remember hearing when I chose to go to medical school. Having never been in my own practice, nor having plans to do so in the foreseeable future, this isn’t something I think about. But recently, I read an article by Isaacs and colleagues entitled “The Independent Physician — Going, Going . . .”1 While the article did not change my opinion about my career choice, it got me thinking about my colleagues who are practicing as independent physicians. Isaacs and colleagues discuss “migration” of physicians from “independent solo or small group practice to larger group practices, where they are often employees.” The Center for Studying Health System Chang estimates that 55.9% of physicians are currently in independent practice, with the largest decline in medical specialists, when compared to primary care physicians and surgeons. Furthermore, the authors also pointed out that the percentage of physician who own their practice has been declining 2% per year for the past 25 years. Another interesting statistic mentioned by these authors is that 9 out of 10 Americans receive their medical care from a doctor in a solo or small group practice. Physician Independence and Patient Care It is unclear how the decrease in physician independence will affect healthcare access for our patients. Are independent physicians more or less sympathetic to patients’ needs than their colleagues in large groups/hospital-based practices? A physician employed by a large group may exhibit the “just work here” attitude. This may translate into not caring about how much or little the physician bills (although most large institutions have formulas to ensure that you are billing several hundred percent of your salary), not caring about the patients’ billing issues — ie, “you have to talk to billing” — and perhaps not caring about whether or not the patient returns for follow-up care. Furthermore, physicians who work for large corporations may not feel as motivated to see all the patients who require care, and with the physician shortage in the United States, this will no doubt affect access to care. But while solo/small group practitioners may feel more “devoted” to their practices, some may perceive the primary motivation here as money or greed. And there is already talk that since salaried physicians may lower the cost of healthcare, perhaps all of us should be salaried employees. Yet we still have to ensure that we are not sacrificing quality of patient care for quantity of patients that we see. Having said that, I doubt any of us will be motivated to see more patients if there aren’t incentives. This, too, will compromise access to care. Convenience vs. Control There are some advantages to being in a large specialty or multispecialty practice. There are colleagues one can ask for advice or refer patients to, vacation coverage is easy and your patients aren’t stranded, sharing space and buying supply in bulk may lower your overhead, large groups may have more bargaining power with insurance carriers, etc. But some physicians may not have a choice but to form large group practices. We may not yet be seeing as much of this in dermatology, but it’s already happening in other medical specialties. What effect will this have on the practice of medicine going forward? Should we even care? Is this a normal process of consolidation? Will doctors simply be employees of large corporations, “punching in and punching out?” As it is we have less and less control of the practice of medicine, overwhelmed with regulations, prior authorizations and decreasing reimbursements. Are we really ready to give up even more control of our own practice? The Right Balance By no means do I think that physicians in either setting provide better care, are more or less compassionate, or care more or less about their patients. I firmly believe that our fellow doctors provide the best care they can, period. But I think it’s important that all options are available to us, whether we prefer a solo practice or being a member of a large medical center. I also think it’s vital for us to remain independent, so that decisions about patient care aren’t made by bureaucrats or business professionals. As long as we continue to place the best interests of our patients first, and we effectively communicate this to the patients and the public at large, we will guarantee our own success. Dr.Goldenberg, Section Editor of Issues in Dermatology, is an Assistant Professor of Dermatology at Mt. Sinai School of Medicine in New York. He is Board Certified in Dermatology and Dermatopathology. Disclosure: Dr. Goldenberg has no conflict of interest with any material in this column.
Is Solo Practice a Thing of the Past?
You can always start your own practice,” is something I remember hearing when I chose to go to medical school. Having never been in my own practice, nor having plans to do so in the foreseeable future, this isn’t something I think about. But recently, I read an article by Isaacs and colleagues entitled “The Independent Physician — Going, Going . . .”1 While the article did not change my opinion about my career choice, it got me thinking about my colleagues who are practicing as independent physicians. Isaacs and colleagues discuss “migration” of physicians from “independent solo or small group practice to larger group practices, where they are often employees.” The Center for Studying Health System Chang estimates that 55.9% of physicians are currently in independent practice, with the largest decline in medical specialists, when compared to primary care physicians and surgeons. Furthermore, the authors also pointed out that the percentage of physician who own their practice has been declining 2% per year for the past 25 years. Another interesting statistic mentioned by these authors is that 9 out of 10 Americans receive their medical care from a doctor in a solo or small group practice. Physician Independence and Patient Care It is unclear how the decrease in physician independence will affect healthcare access for our patients. Are independent physicians more or less sympathetic to patients’ needs than their colleagues in large groups/hospital-based practices? A physician employed by a large group may exhibit the “just work here” attitude. This may translate into not caring about how much or little the physician bills (although most large institutions have formulas to ensure that you are billing several hundred percent of your salary), not caring about the patients’ billing issues — ie, “you have to talk to billing” — and perhaps not caring about whether or not the patient returns for follow-up care. Furthermore, physicians who work for large corporations may not feel as motivated to see all the patients who require care, and with the physician shortage in the United States, this will no doubt affect access to care. But while solo/small group practitioners may feel more “devoted” to their practices, some may perceive the primary motivation here as money or greed. And there is already talk that since salaried physicians may lower the cost of healthcare, perhaps all of us should be salaried employees. Yet we still have to ensure that we are not sacrificing quality of patient care for quantity of patients that we see. Having said that, I doubt any of us will be motivated to see more patients if there aren’t incentives. This, too, will compromise access to care. Convenience vs. Control There are some advantages to being in a large specialty or multispecialty practice. There are colleagues one can ask for advice or refer patients to, vacation coverage is easy and your patients aren’t stranded, sharing space and buying supply in bulk may lower your overhead, large groups may have more bargaining power with insurance carriers, etc. But some physicians may not have a choice but to form large group practices. We may not yet be seeing as much of this in dermatology, but it’s already happening in other medical specialties. What effect will this have on the practice of medicine going forward? Should we even care? Is this a normal process of consolidation? Will doctors simply be employees of large corporations, “punching in and punching out?” As it is we have less and less control of the practice of medicine, overwhelmed with regulations, prior authorizations and decreasing reimbursements. Are we really ready to give up even more control of our own practice? The Right Balance By no means do I think that physicians in either setting provide better care, are more or less compassionate, or care more or less about their patients. I firmly believe that our fellow doctors provide the best care they can, period. But I think it’s important that all options are available to us, whether we prefer a solo practice or being a member of a large medical center. I also think it’s vital for us to remain independent, so that decisions about patient care aren’t made by bureaucrats or business professionals. As long as we continue to place the best interests of our patients first, and we effectively communicate this to the patients and the public at large, we will guarantee our own success. Dr.Goldenberg, Section Editor of Issues in Dermatology, is an Assistant Professor of Dermatology at Mt. Sinai School of Medicine in New York. He is Board Certified in Dermatology and Dermatopathology. Disclosure: Dr. Goldenberg has no conflict of interest with any material in this column.
You can always start your own practice,” is something I remember hearing when I chose to go to medical school. Having never been in my own practice, nor having plans to do so in the foreseeable future, this isn’t something I think about. But recently, I read an article by Isaacs and colleagues entitled “The Independent Physician — Going, Going . . .”1 While the article did not change my opinion about my career choice, it got me thinking about my colleagues who are practicing as independent physicians. Isaacs and colleagues discuss “migration” of physicians from “independent solo or small group practice to larger group practices, where they are often employees.” The Center for Studying Health System Chang estimates that 55.9% of physicians are currently in independent practice, with the largest decline in medical specialists, when compared to primary care physicians and surgeons. Furthermore, the authors also pointed out that the percentage of physician who own their practice has been declining 2% per year for the past 25 years. Another interesting statistic mentioned by these authors is that 9 out of 10 Americans receive their medical care from a doctor in a solo or small group practice. Physician Independence and Patient Care It is unclear how the decrease in physician independence will affect healthcare access for our patients. Are independent physicians more or less sympathetic to patients’ needs than their colleagues in large groups/hospital-based practices? A physician employed by a large group may exhibit the “just work here” attitude. This may translate into not caring about how much or little the physician bills (although most large institutions have formulas to ensure that you are billing several hundred percent of your salary), not caring about the patients’ billing issues — ie, “you have to talk to billing” — and perhaps not caring about whether or not the patient returns for follow-up care. Furthermore, physicians who work for large corporations may not feel as motivated to see all the patients who require care, and with the physician shortage in the United States, this will no doubt affect access to care. But while solo/small group practitioners may feel more “devoted” to their practices, some may perceive the primary motivation here as money or greed. And there is already talk that since salaried physicians may lower the cost of healthcare, perhaps all of us should be salaried employees. Yet we still have to ensure that we are not sacrificing quality of patient care for quantity of patients that we see. Having said that, I doubt any of us will be motivated to see more patients if there aren’t incentives. This, too, will compromise access to care. Convenience vs. Control There are some advantages to being in a large specialty or multispecialty practice. There are colleagues one can ask for advice or refer patients to, vacation coverage is easy and your patients aren’t stranded, sharing space and buying supply in bulk may lower your overhead, large groups may have more bargaining power with insurance carriers, etc. But some physicians may not have a choice but to form large group practices. We may not yet be seeing as much of this in dermatology, but it’s already happening in other medical specialties. What effect will this have on the practice of medicine going forward? Should we even care? Is this a normal process of consolidation? Will doctors simply be employees of large corporations, “punching in and punching out?” As it is we have less and less control of the practice of medicine, overwhelmed with regulations, prior authorizations and decreasing reimbursements. Are we really ready to give up even more control of our own practice? The Right Balance By no means do I think that physicians in either setting provide better care, are more or less compassionate, or care more or less about their patients. I firmly believe that our fellow doctors provide the best care they can, period. But I think it’s important that all options are available to us, whether we prefer a solo practice or being a member of a large medical center. I also think it’s vital for us to remain independent, so that decisions about patient care aren’t made by bureaucrats or business professionals. As long as we continue to place the best interests of our patients first, and we effectively communicate this to the patients and the public at large, we will guarantee our own success. Dr.Goldenberg, Section Editor of Issues in Dermatology, is an Assistant Professor of Dermatology at Mt. Sinai School of Medicine in New York. He is Board Certified in Dermatology and Dermatopathology. Disclosure: Dr. Goldenberg has no conflict of interest with any material in this column.
