What's on the horizon for private practice?

Private practices continue to battle a host of challenges, including economic pressures and reimbursement woes. But how will it affect their future?

Six healthcare leaders connected with Becker's to answer the question, "What's on the horizon for private practice?"

Note: These responses have been lightly edited for length and clarity.

Bernard Boulanger, MD. CEO, Provider Enterprise and Executive Vice President at Tower Health (West Reading, Pa.): The shift from private practice to physician employment was hastened by the pandemic.  I believe that this trend will continue, although not in the same framework that has existed in the past. Physicians in private practice now have more options to consider.  

Recent data from the American Hospital Association demonstrates that private equity, physician medical groups and health insurers have been the three largest drivers of physician acquisitions during 2019-23. Hospitals and health systems represented only 6% of these acquisitions. Private equity can be attractive to those in private practice as it can offer capital investment, increased market power, growth and financial stability, although there can certainly be trade-offs, such as control of practice. 

The corporatization of healthcare is likely to continue and as such, it may be harder and harder for physicians to remain in private practice.   

Jan Duncan, MD. Orthopedic Surgeon at California Spine (Los Angeles): Private practice is under assault. There are more and more rules and regulations with accompanying bureaucrats. Many of these bureaucrats are incompetent. This makes private practice more difficult and requires more overhead. Still, I think that most doctors went into medicine for independence and therefore will continue to value private practice.

Jack Feltz, MD. Chief Medical Executive Officer for Unified Women's Healthcare: Private practice healthcare providers are the cornerstone of our American healthcare system and play a critical role in ensuring wider patient access to high-quality, affordable care. The ever-increasing administrative burdens, regulatory disadvantages and complexities of delivering quality healthcare are driving many private practitioners, reluctantly, out of practice or to health system employment. This has not been shown to necessarily improve quality but often increases the overall cost of care in an already unaffordable healthcare environment. If this trend continues, it is unlikely private practice, with all its benefits to society, will survive. Many private practice providers are committed to saving private practice and are aligning their efforts with better organizational structures, pooled resources, shared learning, improved technology and transformation to value-based care. This will not only help them survive but has the real potential to change our healthcare system for the better with greater access, improved quality and affordability. Only time will tell how this all plays out but on behalf of every patient in this country, I am rooting for private/independent practice to not only survive, but thrive.

Taif Mukhdomi, MD. Interventional Pain Physician at Pain Zero (Columbus, Ohio): The growing discourse between hospitals and insurance companies has provided a sizable opportunity for private practice groups across the country. Private practice has the chance to partner with insurance companies directly. Through competitive rates and specialized care, private practice groups can be an asset to health insurance companies by contracting together, building on each other's needs and providing dedicated care to health insurance members at a fraction of the cost in a hospital setting.

With expanding coverage for office and ASC procedures, private practice groups have the opportunity to reshape the healthcare market towards largely outpatient procedures that are less costly. This is demonstrated in practice trends. CMS continues to value hospital-based procedures compared to office and ambulatory surgery center settings subtly outlined through their annual fee schedule and physician pay cuts. This strategy can work in favor of private practice groups as they partner with private groups and notify members of affordable options that can provide more streamlined care. This strategy can direct patient care to more cost-conscious options for insurers and patients alike. All the while, financial constraints will continue to push Medicare and Medicaid patients away from private practice and into the hospital setting.

Bruce Robinson. Provider Recruiter at Mercyhealth Wisconsin and Illinois (Rockford, Ill.): Physicians continue to move away from private practice for similar reasons chefs move away from launching restaurants — they are too difficult to operate and profit.

Yet, psychiatry, neurology, dermatology, ophthalmology, rheumatology, urology, and of course, plastic surgery can still perform well on a private model.

However, for private practices to flourish, private practices must have superlative staff, state-of-the-art scheduling/billing software, efficient operations, and an exciting culture (front and back). Do not neglect the emerging artificial intelligence technology. AI's usage will only increase in healthcare, especially in the next year. Make friends now.

A compelling value proposition must be in place. This both attracts and retains patients. Without it, a private practice is merely another usual entity. And patients are never excited about experiencing anything vanilla.

Think like a founding entrepreneur and approach a private practice as a start-up. In reality, private practice is just another definition of a start-up.

James Tinsley, MD. Family Physician at Lighthouse Direct Primary Care (Newport News, Va.): I'm a direct primary care family physician, and our future looks great. I opened my practice in 2019, six months before COVID-19. We were the first direct primary care practice in our area. There are four now. Even with the laws against free market medicine …) we are still growing and thriving as are other practices.

My patients get same/next day 30- to 60-minute visits and unlimited visits without a copay. We also shop for medical care and make it affordable for them. As a reward, I get to be the physician I always wanted to be. I truly love my job.

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