While the future of independent practice remains relatively uncertain as consolidation rises across healthcare, many physicians are debating a switch from employed settings as feelings of satisfaction and autonomy continue to decline.
Those eyeing the switch to independent practice have a number of important factors to consider:
Various models for private practice
Physicians identify administrative hurdles, often related to payer policies and processes, as key disruptors to physician practice flow. This has led some physicians to consider a switch to less traditional practice models, including concierge practices and direct-care models.
Susan Baumgaertel, MD, an internal medicine physician in Seattle, said that these different models are often conflated by physicians and patients alike. But acknowledging the differences between these models is key for physicians who are deciding what approach works best for them and their patients.
Dr. Baumgaertel said that while there are concierge practices that are very “high end,” and essentially always on call for their patients, as some may assume, it is not a catch-all term.
“That’s definitely nothing to do with what I’m thinking of when I think about alternate models that are sustainable for all,” she said. Dr. Baumgaertel practiced at The Polyclinic in Seattle for 25 years, where she also had an ownership stake, before launching her independent telemedicine practice, myMDadvocate. She bills patients for her time, likening her model to that of a law firm where patients have direct access to her expertise and care.
“If you actually drill down and do the math, it’s very insightful and elucidating, because most people think ‘Oh wait a minute, I have to pay like a monthly fee. But what if I’m not getting seen, I’m well, but I pay that anyway, and that’s a lot of money. I still need insurance,'” she said. “Well, if you sat down with a ledger, and figured out how much things cost, you could theoretically save money going that route. For example, let’s say you pay $200 a month, which is a lot of money. But let’s also say that every time you’re sick, you pay nothing and receive free care with no additional charges.”
By also accounting for how many times a year someone sees a physician and other perks that may come with a direct-pay model, such as a free physical, patients may actually save money compared to what their cost of care would be through traditional health plans and practice structures.
Dr. Baumgaertel encouraged physicians to push past the assumption that concierge care is only for the wealthy and get creative in designing models that will suit the needs of them and their communities.
“It’s not even care for the middle class. It’s just care,” Dr. Baumgaertel said. “Care for people who are actually thinking about where they want their dollars to go.”
Financing options
Financing is a key question for physicians looking to move toward independent practice as operational costs continue to climb.
Becker’s has reported on several emerging business models looking to subvert traditional practice acquisition and consolidation trends.
New York City-based Sapient Health, owned by Joseph Romano and Bill Ingram, has “the expertise of a large management company while maintaining a personalized, startup-like feel,” Mr. Romano told Becker’s. The company emphasizes regional representation, focusing on New York, New Jersey and Florida. They also operate a physician-driven model in which the firm enters deals as a minority partner, ensuring that physicians retain leadership while gaining business acumen for long-term success.
Matawan, N.J.-based management services company Redefine Management utilizes a vertically integrated model to offer a full spectrum of tailored management solutions, empowering physician groups and healthcare providers with the infrastructure they need to succeed. Redefine’s CEO William Vanderveer recently told Becker’s that, through the company’s partnerships with medical groups, his company is able to deliver the benefits of traditional health system alliances, like more favorable payer contracts, while preserving physician autonomy and independence.
Partnerships and comradery with other physicians
While many factors point to a decline in private practice, other factors indicate momentum for physicians looking to remain independent.
According to a survey from consulting firm Bain & Co., nearly 25% of physicians in health system-led organizations are contemplating a change in employers, compared to just 14% in physician-led practices. Notably, of those considering a switch, 37% are looking to move to physician-owned settings.
“We’ve seen this trend empirically,” Jeremy Shiner, founder and CEO of Myriad Systems, a provider of AI-driven healthcare practice management solutions, told Becker’s. “This shift is evident not only in direct primary care and physician-led concierge practices but also among providers who might not appear in the statistics — those working in hospitals while also running concierge practices on the side. The common assumption that private healthcare is disappearing in favor of hospital systems isn’t as clear-cut when we observe what’s happening in the field with our clients.”
The Bain & Co. survey found that 81% of physicians in physician-led organizations were satisfied with their involvement in strategic decision-making, compared to just 50% of those in health system-led practices.
