Physicians fleeing private practice
News reports have detailed an exodus of physicians from private practice of such large proportions that Gordon Smith, executive vice president of the Maine Medical Association, calls it "an epidemic."
While there are no hard and fast numbers tracking the migration from private practice to large physician group practices or to hospital settings, state medical associations across the country say it's definitely happening.
Jennifer Hanscom, associate executive director/chief operating officer of the Washington State Medical Association, said about 40 percent of the WSMA's members are in groups of 100 or more, and in its March report, the organization cited that at least five large strategic alliances between hospital systems (or hospitals) and physician groups had formed in the state in the last year.
All the large cardiology firms in the Columbus, Ohio area have been purchased by hospitals, said Mark Jarvis, senior director of practice economics at the Ohio State Medical Association. "We have seen more of a migration of doctors in small practices going into an employment setting with, typically, a large institution. We also probably have fewer start-up practices than we normally would," he said.
"Physicians are getting out for a number of reasons: For lifestyle issues; because of the need for access to capital; for administrative help, billing, coding. Health information technology is a big part of the (Affordable Care Act)," said Walker Ray, a retired physician and vice president of the Boston-based Physicians Foundation, a physician advocacy group.
"This is not an easy transition to health information technology for physicians," he said. "We understand that it's necessary. It needs to occur. It's going to occur. But it's expensive. There are needed resources that physicians many times don't have. There is expertise that they don't have. All these taken together as a confluence are making it more attractive for physicians to move toward an employed type model."
All the reasons cited by physicians for getting out of private practice are valid, Jarvis and Ray said – but there are good reasons to stay, too.
Private practice physicians have more control over how they practice medicine, are able to determine the scope of their practice and, having been trained throughout their medical school experience to be independent thinkers, are uniquely suited to the autonomy offered by private practice.
Private practice is not dead, Jarvis said. He thinks the trend of physicians leaving private practice is likely to reverse itself as the repercussions of healthcare reform create new business models that are yet unknown.
"We are heading into very changing times," he said. "I think that opens up a lot of opportunity, maybe on both sides, because I think we can kind of step away from private practice versus employed and say … 'What's the highest quality, cheapest and most satisfying way of taking care of the patients?' Let's figure that out first and then decide what's the best business model."
