Editor’s note: Responses have been lightly edited for clarity and length.
Michael Patmas, MD. Physician Executive (Wailuku, Hawaii,): Personally, I do not see private practice as being feasible for the majority of physicians. Employment is here to stay. Those physicians who can make it in private practice will likely have concierge niche practices.
Justin Calvert, MD. Assistant Professor of Anesthesiology at Loma Linda (Calif.) University: Physician practice ownership is undergoing significant transformation, with nearly three-quarters of all physicians now being employed rather than practicing independently. Hospitals and health systems, private equity firms and corporate entities are all seeking to increase integration by employing physicians. Physicians are also seeking these employed positions due to increasing healthcare complexity, financial uncertainty and a renewed focus on physician well-being, limiting the appeal of private practice models.
Robert Pearl, MD. Professor at Stanford (Calif.) University Medical and Business School: In 2025, physicians in private practice will experience even more pressure with burnout rates continuing to be around 50%. Costs of running their offices will rise more rapidly than
Payments — both from the government and insurers. As a result, private practice physicians will be forced to do more with less. Two opportunities will exist to transform private practice. The first will be joining with colleagues in the community to offer value-based medical care. And the second to embrace generative AI and help patients use this technology to better manage their acute and chronic diseases. By year’s end, a small number of doctors in private practice will have begun to experiment with each.
Harry Haus, MD. Medical Director of Dr. Haus & Associates (Erie, Pa.): [Medicare Advantage] is paying $35 to $38 for most office visits. Medicare payments continue to be decreased. Many commercial insurers’ pay [is] based on Medicare rate. Also, the new [exclusive provider organization] insurance products require the patient to be seen by a doctor they own. Hospitals often only allow doctors they own on staff. The government required us all to get expensive electronic prescribing software to stop the opioid epidemic. It did not work. Malpractice rates still are climbing. Finally, the cost of many medicines is too high for patients with high deductibles. There is no help from the medical societies since the board members are all employed. Twenty-three years ago, I was on the board of the Pennsylvania [Academy of Family Physicians]. I was the only doctor not employed by a hospital or insurance company. The [electronic medical records] and all the clicks about things other than medicine, as well as closing for lunch and no Saturday hours, mean patients now wait months to be seen rather than days. This causes the ER to be over-used and care to be very fragmented. The result is expensive, poor care, often not even given by a physician. This all hurts the survival of private practice.
