Why physicians are choosing independent practices over hospitals

While many physicians are flocking to the security of employed models, others are finding that large practice groups can give physicians access to economies of scale without sacrificing autonomy. 

Michael Boblitz, CEO of Tallahassee (Fla.) Orthopedic Clinic, joined Becker's to discuss why physicians are looking to large orthopedic groups as an alternative to employment. 

Editor's note: This interview was edited lightly for clarity and brevity. 

Question: What's the best employment model for physicians?

Dr. Michael Boblitz: When viewing the orthopedic market, the private practice environment has divided where smaller groups can no longer thrive and grow in the healthcare industry. 

Large orthopedic groups, such as Tallahassee Orthopedic Clinic, that I define as 70 or more physicians and advanced practice professionals with the full range of in-office clinical services, have the financial strength and governance model that is and will continue to attract orthopedic surgeons coming out of residency programs, fellowship programs or who are currently employed by hospitals or other entities where orthopedics is far from the top priority. 

The following are just a few of the drivers behind physicians joining large independent orthopedic group practices:

  • To enjoy true collegiality of a physician-led enterprise where clinical decisions and decisions about the appropriate level of clinical support staff are made by physicians and not administrators 
  • To embrace entrepreneurship and innovation where a physician (not the employer) can control his or her income/earnings
  • Ownership offers orthopedic surgeons the ability to share equally in ancillary income, real estate and ASC distributions that provide for a better life both before and after retirement. These alternative sources of income also serve as a means to reinvest in the expansion and enhancement of clinical facilities that continually improve access to care. The alternative ... a 401(k) match.
  • The research on the clinically focused factory is well documented and demonstrates specialized care, such as orthopedics, delivers markedly reduced variations and significantly improved outcomes.
  • To serve in a model that payers, employers and consumers embrace, private orthopedic groups offer high quality care at a lower price compared to hospitals that prioritize the higher-cost emergent and complex patient populations. 
  • To offer fully integrated patient care, where all clinical, diagnostic and therapeutic care is centralized in one electronic health record, allowing providers to be fully empowered with information. Smaller groups lacking the full range of clinical services, or hospital- employed practices with ancillary services at higher hospital-based price points, drive patients into alternative provider settings with different electronic health records, resulting in fragmented clinical information.
  • Private orthopedic groups hold the ability to enter into strategic partnerships that create value for the orthopedic practice and the patient. Other larger entities that span broadly beyond orthopedics have separate and often many different agendas that dilute orthopedic partnership opportunities.

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