Almost half of independent physicians expect to sell their practices within the next 10 years, though almost three-quarters would rather not do so, according to a new survey. Many think the trend of independent doctors moving into big health systems will reverse at some point, but financial realities and a changing policy landscape are at least momentarily endangering physicians outside of bigger systems and facilities.
In the survey, by health care consultant ProCare Systems, 44% of the 82 respondents expected to sell their practices within 10 years, but 73% said they don’t want to sell.
This trend is “a manifestation of the heavy hand of government intervention in every aspect of health care,” said Dr. Bill McClelland, the founder of a large otolaryngology group in Charlotte, N.C. He cited the logistical and administrative burden required of all physicians, from patient visit forms to lab work write-ups, and from HIPAA requirements to tax forms. “Is it any wonder that the independent physician feels overwhelmed and reaches out to anyone who can shelter him or her from this burden?”
Two-thirds of survey respondents said they felt that rising costs and downward payment pressure was the most or second-most pressing challenge to their independence. Maintaining referral streams – essentially, competing with larger health care systems for patients – was second on that list of challenges.
Independent physicians need to get creative to battle those pressures, said Dr. Wissam E. Nadra, of Lakeshore Pediatric Center in Denver, N.C. “We need to offer more conveniences to [our] patients, such as telemedicine services, concierge medicine, house calls, and integrative and holistic medicine,” he said.
Dr. Wissam E. Nadra
Aside from making improvements in their own practices, independent physicians are getting on board with new practice and business models that could help relieve some of those pressures. Independent practice associations (IPAs) are becoming more and more common, and 49% of the survey respondents said they would be interested in such models, with particular focus on increased negotiating power with payers. Smaller numbers suggested they might be interested in practice management or shared equity models (28%), and simple mergers with other practices to take advantage of economies of scale (23%).
A 2012 report from consulting firm Accenture shed light on the ongoing trend away from independent practice. In 2000, 57% of U.S. physicians were independent; by 2012, that had dropped to 39%, and was projected to drop to 36% only a year later.
In spite of the current environment, many physicians believe the trend will eventually reverse itself, perhaps once some of those newer business models begin to take hold. In the new survey, 72% said they envision a reverse trend where doctors in bigger systems leave to become independent.
“I believe that independent practices will actually begin to proliferate again once they become part of an organized effort to collaborate information and resources,” said Dr. Larry F. Berman, an internist in Charlotte, N.C. “I learned long ago that [my practice] must be run as a business in order for it to proliferate and survive.”
At the root of all of this, of course, is how these trends might affect patient care and outcomes. Most survey respondents (88%) agreed that payment will eventually become dependent on clinical outcomes measures that demonstrate quality and value, which many independent physicians believe will favor them over bigger systems.
“Maintaining independence is important to me,” Dr. Berman said, “as I believe that it will provide better patient care for a fraction of the cost.”