Monday, October 5, 2015

Physician Owned Private Practice Is Still Alive and Well: Here's Why

A death greatly exaggerated...
The Population Health Blog recently broke bread with a Director at the Tucker Advisory Group.  TAG provides professional services to a host of health care entities, including physician-owned provider groups.

The PHB has been skeptical about the death of private practice, and the breakfast did little to change its mind.

What it learned is that there is no shortage of business for outfits like TAG.  A typical private practice client is a group of ten or more physicians with multiple clinics in a multi-county area serving thousands of patients.  These groups range from primary care to pain management to women's service to cardiology.  While their revenues and expenses cannot be taken for granted and payer hassles abound, it's not impossible for a nimble and hard-working group of private practice docs to serve their patient population and still end the year in the black.

In addition, it hasn't been that unusual for individual physicians who are in salaried positions in large hospital-dominated provider organizations to contact TAG to explore the options for going into "private practice."

Anecdotal you say?

Despite the narrative that the death of private practice is "unstoppable," there are plenty of reasons to be contrarian:

1) The latest good information (like this) on physician employment that supports the narrative that private practice is dead is from the AMA's 2012 data base.  While newer data from 2014 indicate that independent primary care practice is dwindling, there are pockets of specialty physician private practice that are remaining strong. In other words, one reason for the growth of salaried physicians is their flight from continuing struggles of primary care, not toward the advantages of employment.

2) Whether they're in a salaried position or in private practice, today's physicians are still demanding autonomy, adequate resources, input and to be rewarded.  Given reports like this and this on getting docs to do what they're told cooperate, is it any wonder that physician entrepreneurship is still alive?

3) And speaking of being rewarded, physician compensation in ACOs don't appear to provide any particular advantages.

4) What about the patients, you ask?  Good question, and you can be sure that the docs are asking it too.

The point?  Large hospital-provider systems relying on salaried physicians are an important option in health care reform.  The PHB suggests that reports of the death of private practice have been exaggerated and it will also remain an important option. 

Stay tuned!

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