Is solo practice going the way of the dinosaur?

The Dinosaur TimesKaren Caffarini at American Medical News reports that hospitals and physicians, both finding themselves in dire financial circumstances, are increasingly working together to make a go of it.  One of the forms this cooperation is taking is a continuation of a longstanding trend: hospital-run physician practices:

Past surveys have found physicians moving toward employed or hospital-based situations long before today’s economic crisis. For example, a survey by the Center for Studying Health System Change found that there was a marked increase in the percentage of physicians joining large, single-specialty groups and employed situations. The survey, released in August 2006, covered 1996 to 2005.

Running one’s own practice requires a lot of time and hard work.  It also requires some business sense and a fair amount of knowledge about practice management, health information technology, and coding and billing, among other skills.  But this investment grants the physician a much greater degree of autonomy.

I am constantly amazed and perplexed by the move away from independent practice.  In uncertain financial times isn’t it better to be in control of one’s professional and financial destiny?  I could name a lot of physicians I know who were lured into hospital-run practices by the promise of financial security.  They thought they could just practice medicine while hospital administrators and their staff took care of practice management.  What they ultimately discovered was the wisdom of the old maxim “He who pays the piper calls the tune”.  These physicians found themselves being asked to see more patients per day by hospital officials.  A colleague of mine recently turned down a job because his would-be employer wanted him to order unnecessary blood tests like complete blood counts (CBC) on patients who had viruses and acute sinusitis so the employer could pay for his company’s expensive in-house CBC machine.  My area also has a number of empty medical clinic buildings with “for sale or lease” signs in the front lawn.  These signs materialized shortly after the aforementioned financial security promised by having a hospital or other third party run one’s practice dematerialized.

A decade ago, Family Practice Management contributor and FPM blogger Dr. Douglas Iliff declared solo practice the way of the future.  Despite the above AMN report, I still think he’s right.

Photo credit: VINTFALKEN.COM
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