As part of the medical community, you have probably heard rumors about the demise of the independent practice. With COVID, the fluctuating economy, and burdensome insurance requirements, the news, indeed, has been somewhat dire. Research from the American Medical Association revealed that, “The majority of patient care physicians worked outside the traditional physician-owned medical practices in 2020, the first time the share of physicians in private practices dropped below 50% since the AMA analysis began in 2012.”
“As independent practice owners that have the opportunity to give patients a high value, high satisfaction experience, we need to be teaching patients they don't need to go to the emergency room for a cut finger, and we need to get them to focus on getting care in the right facility. In all this reform, we lost sight of getting patients to focus on primary care, and that's the most important thing.”
Contributing factors to this decline can be found in the difficulty of managing a private practice, while trying to maintain a healthy work-life balance. The hospital option seemed like the perfect solution for many harried independent practitioners. Keep in mind, though, that this particular survey was conducted about six months into the pandemic. Since then, being a doctor in a hospital environment has become a highly stressed, personally fraught position.
Perhaps doctors who might have once thought of hospital employment as the answer to their personal needs may now look at the reported demise of the independent practice as Mark Twain once did when confronted with rumors of his own earthly departure. “The report of my death was an exaggeration,” quipped Mr. Twain. When the internet widely reported that he had died, country music legend Willie Nelson turned it to his advantage, releasing a bouncy song featuring the lyrics, “I woke up still not dead again today.”
And so, it might not yet be time to sound the death knell for the independent practice. As COVID-19 continues to wreak havoc, overburdening hospitals, Intensive Care Units, and medical providers alike, many are now rethinking the advantages of leaving the hospital space and opening an independent practice. This article will take a look at some indicators which reveal just why the tide might be turning.
The Pros and Cons of Working in a Hospital Environment
On its surface, working in a hospital can seem like quite an inviting opportunity. Positive aspects include:
- Ability to focus on patient care, without worrying about administrative burdens, fighting with insurance companies, or managing office staff.
- Doctors usually work on a set schedule in a hospital environment; however, this can often include holidays, night shifts, and weekends.
- Medical providers receive a set compensation schedule. The doctor can expect a certain amount of pay, regardless of the number of patients seen.
- Hospital pay packages can include substantial perks, such as retirement account contributions or paid liability insurance coverage.
- Dealing with patients in private practice can often revolve around routine appointment and “well care” visits, which may not provide sufficient challenge. A hospitalist has the opportunity to see a variety of patients, often with challenging medical situations, on a daily basis, and works with a number of team members to achieve patient health goals.
The benefits, of course, are contingent on the specific hospital environment. Some hospitals are quite large, and are rife with competitive pressures, while others are small and demand a great deal of commitment from their physicians. In addition, a hospital doctor only sees each patient for a limited time span. Once the emergent problem is addressed, the patient is released, and the doctor may never see this person again.
Doctors in a hospital cannot choose which patients they see; some may be unruly, chronically ill, or suffering with severe substance abuse problems. Dealing with families that constantly make demands for their loved one’s care can be mentally and emotionally draining.
COVID-19 quickly dissipated the benefits long associated with hospital practice, and forced physicians to rethink their career choice. Hospitals became overwhelmed with severely ill patients, and staff felt the strain of caring for people who had no access to familial support systems. Prevention protocols were intense, requiring constant changes of personal protective equipment and extreme vigilance regarding sanitary procedures. Countless providers and healthcare workers became sick or died trying to help their patients survive. For many, the stress was just too much, and they made the self-preservation decision to leave.
The Advantages of Being in an Independent Practice
Although there can be challenges and uncertainties associated with operating a private practice, the benefits are once again beginning to look very appealing:
Ability to Be Your Own Boss
Doctors in independent practice have full autonomy to choose where they will locate a practice, and to set their own hours. They can arrange coverage when time away is needed for a break, offering the opportunity for a better work-life balance. Independent practitioners choose which type of patients they want to see and make their own decisions regarding treatment plans. There is no need to consult a patient care committee or go before a board to determine if an approach fits within approved protocols. If the doctor feels a certain test or procedure is warranted for a patient’s health condition, but the cost might be too high, there is more leeway on alternative financial approaches.
Forming Better Relationships with Patients
Doctors in independent practice are able to create continuity of care with their patients. Many establish long-term, and even life-long, relationships as they manage health challenges through every life phase.
Opportunities to Increase Earning Potential
An independent practitioner can bring in a partner or another provider to expand care capabilities and increase income. When ready to retire, the founding physician has an asset to sell, which can establish a nice nest egg.
Increased Earning Potential
According to the Medscape employment survey, “65% of self-employed doctors are satisfied with their current practice situation. Of medical professionals who ventured out into private practice, 70% reported being happier after switching, compared to just 49% of people who work in a network.”
How Technology Makes It Easier to be in Private Practice
“Care delivery is changing. As example, COVID-19 has made the case for telehealth’s arrival that will extend well beyond this crisis. Healthcare as we know it/knew it, in many ways is no longer the standard. Still, the aim of delivering high quality, cost-efficient care, and improving the patient and clinical experience, remains.”
~ Shawn Morris, CEO of Privia Health
Medical Economics, May 6, 2020
One great advantage of modern society is that the independent medical practitioner can have access to the same high levels of technology that were available in the hospital. In some cases, the independent doctor may be able to react even faster, quickly making decisions that are best for the practice, without having to go through layers of bureaucracy. Some ways in which technology is making life better in private practice include:
Telehealth
Initially slow on the uptick, telehealth made vast inroads into the medical community during the height of the COVID pandemic. Doctors in hospital and private practices soon found that they were able to deliver an ongoing continuum of care by tapping into the wide availability of digital devices. Telehealth solutions increase the ability of the doctor in a private practice to remotely deliver in-home patient care that is comparable to an in-office visit. Providers can quickly and easily initiate telehealth video and secure text conversations, and maintain logs of those chats and videos for billing and audit purposes. In rural areas, where access is not as widespread, the federal government is set to invest over $19 million to expand telehealth nationwide and improve health in rural, often underserved communities. Funds will be used to update technology, train providers, and educate patients.
Electronic Health Records (EHR)
Within the hospital environment, doctors often have access to EHR charting; however, the technology may be slow and ponderous, as hospitals often engage in cost-cutting measures and don’t frequently update this tool. Components of the latest in comprehensive EHR systems include easy charting capabilities and templates to maximize provider time, e-Prescribing, better scheduling capabilities, and a patient portal for enhanced communication purposes – all components that are critical to the smooth functioning of an independent practice.
Virtual Preventative Care Assistant
Another advancement that is helping to maintain care levels in the independent practice is a Virtual Preventative Care Assistant. Amazing Charts now offers the capability to add external remote care services to the patient care kit by adding remote staff, or contracting out existing staff, to reduce labor costs while maintaining patient continuity. This takes a huge administrative burden off of the independent practitioner, while maintaining care levels.
Medical Billing Service
The area that often causes the most stress for hospitals and independent practices is coding, billing and collections. Getting paid promptly is even more important for the independent practice, which does not have other forms of income to rely on while haggling with insurance providers. For the small to medium-size private practice, Amazing Charts Medical Billing Service provides a fully integrated Revenue Cycle Management service that efficiently handles the billing process for you, and at a more affordable rate than most third-party billers. Your practice could experience an increase in collections, a higher rate of claims paid on first submission, and a quicker time to payment with your payers and patients – all of which are crucial to maintaining a healthy cash flow.
Case Study of a Return to Private Care
“Keep up with the balancing act of offering high quality and satisfaction at a low cost. To have high satisfaction, you have to have quality, but you also have to reduce cost. It's a continuous, evolving balancing act, but the reality is we can offer better service and a better experience for the patient at a lower cost.”
The American Medical Association outlined a case study for Jim Milford, MD, who once developed a network of medical clinics for a large regional medical center in Wisconsin, and later went on to establish his own private physician practice. Although successful in the hospital practice, Dr. Milford found personal relationships eroding as the demand to grow increased. The hospital was eventually purchased by an organization headquartered in another state, further adding to the feel of a corporate environment.
Seeking more creativity and freedom, the doctor eventually decided to turn to the private arena. Founded in 2017, the practice now has over 2300 patients and aims to innovate in a way that allows for an individual focus on patients and a team-based approach to care. Even during COVID, the practice was able to quickly adapt on its own, without having to wait for long-delayed decisions from corporate overseers.
The decision to make the leap from hospital to independent practice is not one to be taken lightly. Practitioners need to look at their own needs and capabilities, recognize their frustrations with the current system, talk with their family or loved ones, and solicit insights from those who have already made the same choice.
One factor that helps to make the switch easier is realizing that there is an abundance of high-quality, tested, and professional electronic solutions which were specifically designed to support the independent practice.
Healthcare Technology Solutions Designed By and For Independent Practices
Amazing Charts was founded in 2001 by a practicing family physician to help medical practices thrive. We have grown consistently since then by creating easy-to-use solutions for delivering patient care. Today, we offer a variety of additional capabilities designed to help independent practices succeed, including Electronic Health Records, Practice Management, Billing Services, Population Health and Remote Care. Call 866-382-5932 to learn about our products, schedule a practice consultation, and learn more about telehealth pandemic lessons that can help your independent practice grow.