Here's what could draw more physicians to private practice 

Private practice can offer physicians more autonomy, but rising overhead costs and declining reimbursements are pushing more toward hospital employment. 

Six physician leaders spoke with Becker's about how the healthcare industry would need to change to allow more physicians to open private practice. 

Editor's note: These answers were edited lightly for clarity and brevity. 

Gabriel Ionescu, MD. Gastroenterologist at Wyckoff Heights Medical Center (New York City): The current employment model will drive the talented physicians with a bit of appetite for risk to private practice. The challenge is that each physician is trading in a comfortable [employed] position, albeit with limited autonomy, for potential financial risk. Keeping a practice open will take more effort to comply with government regulations and reporting, so reducing the burden may help. Unlike employment, an independent physician will have to take more charge of the customer service and management aspects. This may affect work-life balance in the short term; long-term survival will depend upon creation of avenues for passive income, although this may be challenging in certain states in which regulations may empower hospitals over smaller practices on building ancillaries such as ASCs. Ultimately, insurers may need to step in, as care in an ASC is cheaper than in the hospital for the majority of private practice patients. Eventually, building and monetizing the equity of the practice should be enough to incentivize physicians to seek alternatives to employment. 

Alok Sharan, MD. Spine surgeon at NJ Spine and Wellness (East Brunswick): There are three skill sets that physicians need to have to open up their own private practice.

  1. Practice management knowledge: There is some basic knowledge about practice management that every physician needs to learn in their training. This includes the basics of corporate structure. Next, physicians should understand the revenue cycle management process, including how to verify a patient's insurance, determine their benefits and eligibility, submit a claim and the basics of the appeal process. Finally, the physician should understand the basics of malpractice, how to set up an office, how to hire staff and the local laws for hiring employees.
  2. Marketing knowledge: Increasingly, medicine is becoming more competitive. Physicians need to develop a unique set of skills or provide a unique service that helps to distinguish themselves. By distinguishing themselves, patients will come to a physician because that provider can deliver a unique service. Marketing consists of creating a unique brand and using the proper channels to communicate that brand. Ultimately, a physician needs to understand what their unique message is and what channel they want to use to communicate that message. If done improperly, marketing can easily become a money pit with a lot of time and resources being wasted.
  3. Psychology: Starting a business and being an entrepreneur can be very stressful. There will be some natural victories, and of course, failures. This is normal when you take any risk. Developing the right mindset and having the right mental perseverance required to succeed in the face of uncertainty requires tremendous confidence and mental strength. It can be done, but physicians need the proper psychological mindset to succeed.

Cory Calendine, MD. Orthopedic surgeon at the Bone and Joint Institute of Tennessee (Franklin): Physicians who are providing direct patient care must be properly valued by the system in order to preserve the private practice model. The current trends of consolidation, hospital/health system employment and private equity are trying to provide protection from reimbursement rate reduction and distribution of cost for IT systems which are required due to increasing administrative requirements. For many, the lines of increasing overhead and declining revenue have crossed. Financially incentivizing practitioners (by federal and private programs) and easing regulatory burdens will be necessary to preserve private practice physicians. 

Judith Gorelick, MD. Assistant clinical professor of neurosurgery at Quinnipiac University's Frank H. Netter School of Medicine (North Haven, Conn.): At this point, the cost of running a private practice continues to increase as reimbursements decline, which makes it difficult to have a successful private practice. Unless, perhaps, if the practice is successful at supporting ancillary service lines, which is also expensive to add and maintain and often does not have the level of profit margin that can offset the more traditional clinical revenue streams. Also, the cost of updating and maintaining the practice EMR and IT needs is a huge financial burden on most practices. 

Ian Armstrong, MD. Neurosurgical spine specialist at Centric Health (Bakersfield, Calif.):  I do not believe the individual, lone-wolf physicians have a future. Medicine has become so complicated. The complexity of running a business in today's marketplace is too overwhelming and leads to eventually less time to focus on our patients, high stress levels and low job satisfaction. The running of a private practice requires a CEO, CMO, COO, human resources, marketing and social media director, in-house legal team, compliance officer, ombudsman and a community liaison. This can only be accomplished in a very large private practice group setting. So, creating a medical business environment that enables the development of large independent private practice groups would be beneficial for enabling private practice to flourish

Jae Jung, MD. Rehabilitation physician at UCLA Spine Center (Santa Monica, Calif): The insurance companies need to change. It's difficult to get fair contracts for reimbursements for startup solo practices because they have much less leverage than the hospitals. In addition, you need to have more staff (which creates a larger overhead) to deal with insurance companies for denials, authorizations, resubmissions, etc.


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