As physicians continue to explore new, more financially sustainable models for independent practice, membership-based structures have arisen as one way that physicians can reclaim autonomy without operating entirely outside of insurance.
The model may be even more beneficial for certain specialties that depend more heavily on insurance to pay for medications and treatments, but also require significant care and guidance outside of procedures and medication that can be difficult to access in traditional practice models or health systems.
Reeti Joshi, MD, a rheumatologist in Beaumont, Texas, has operated an independent, membership-based rheumatology practice for the last year after leaving employment in 2017. She recently joined Becker’s to discuss how she was able to expand her practice to include new service lines through the membership model and what is preventing it from becoming more widespread.
Editor’s note: This response has been lightly edited for clarity and length,
Question: What do you think is holding back non-traditional private practice models like yours, and what would help them become more ubiquitous?
Dr. Reeti Joshi: There’s a certain degree of lack of knowledge and then a certain degree of fear.
The first hindrance is knowledge. I immediately thought, “Oh my gosh. Now I cannot bill insurance, and I cannot see Medicare.” And that’s a no-no, because those are the people that would benefit the most from this model. They are the ones that stand to benefit the most. So for me, getting rid of insurance and Medicare was a no. I would never do that because that would also mean I would cease to practice rheumatology, in a way, because all our medicines are covered by insurance.
The second [hindrance] is a little bit of a stigma, right? I mean, what if you fail? What if you really are not successful? Going in, I had made up my mind that I was going to do it for three years. And if, at the end of three years, if I was unsuccessful or unhappy or it did not meet the needs of my patients, then I could always go back to traditional medicine. There is no one stopping you from going back and doing what you were doing. You also have to be uniquely positioned in the sense that you have to give yourself time. One year is certainly not enough. The knowledge curve is very steep. I went in prepared, because this is sort of the lifestyle I live. I had done a lot of reading, and then I did even more reading on cardiometabolic health, and where it cross sections with autoimmunity and the effect of diet and exercise and meditation, all those things that I practice in my own life I thought would be so easy to put into place for a practice. But there’s a very steep learning curve.
Your staff has to be 100% engaged. They have to live and breathe this model, otherwise you’re not going to be successful if they do not believe in what this preventive care model from a rheumatologist is, and they don’t practice that type of a lifestyle themselves — to some degree. Not everyone can do it 100% all the time, and I’ll be the first one to admit that there are cheat days and there are cheat weeks, and you know, there are things that we do that we shouldn’t do, that we know, but then we need to course correct and come back to healthy eating and healthy behaviors and no digital time in bed and things like that. But your staff has to truly believe in it too. They have to live and breathe that rather than just be there to do the work. In my opinion, it would take me three years to truly know the impact I made, because we’re only one year in, but we know that this is the way to go further.
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