The fate of the small GI practice: Independence or strength in numbers?

Physician practices across many specialties are opting for hospital owners or merging to leverage the power of larger numbers, but does this trend hold as much sway for small GI practices?

Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit responses.

Next week's question: If you could change one thing to improve healthcare and the GI field, what would it be?

Please submit responses to Carrie Pallardy at by Thursday, October 15, at 5 p.m. CST.

Maxwell Chait MD FACP, FACG, AGAF, FASGE, ColumbiaDoctors Medical Group (Hartsdale, N.Y.): Although many independent practices are opting to become part of a hospital system or a larger practice to stay in business, smaller gastroenterology practices may be able to survive. For a smaller GI practice to survive, practice leaders need to evaluate the market and competitors and assess the practice's financial situation to become more competitive compared to practices of similar or larger size in its local market.

When deciding whether to remain independent or participate in these arrangements, GI practices need to analyze the risks and benefits of the joining other practice arrangements or remain as an independent GI practice. Some of the more critical criteria regarding the decision of the GI practice to become part of a hospital system or larger practice include the loss of control over the direction and operation of the practice, the implications of being an employee rather than a business owner and the ability of gastroenterologists and employees to function effectively and thrive professionally in the different larger culture.

To remain in business, practice leaders need to assess their EMR and other technology solutions that will either contribute or diminish productivity and efficiency, evaluate insurer contracts and delivery systems to assure the financial integrity of the group, know which providers give the highest value of quality, access and cost for the GI practice and its patients and assess staffing of clinical and non-clinical employees for the volume and acuity of patients to move into this new healthcare world. Essentially, GI practice leaders must have the necessary skills for data analysis and strategy and understand the financial situations they will face as the new healthcare system evolves.

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