Brian Larkin, MD, chief medical officer at Denver-based Orthopedic Centers of Colorado, joined Becker’s to discuss physician workforce issues.
Editor’s note: This interview was edited lightly for clarity and length.
Question: How do you anticipate the physician workforce changing over the next five years?
Dr. Brian Larkin: I believe that the physician workforce will continue to change dramatically over the next five years. I believe we will continue to see increased utilization of advanced practice providers to support physician workforce decline. I believe that there will be continued pressure on independent practices, but the opportunities in alternative employment opportunities will start to shrink. I suspect these forces will challenge patient access to care on a regular basis.
Q: With the decline of independent practices, where do you see most physicians transitioning — hospital employment, ASCs, private equity-backed groups or other settings? What factors are driving these shifts?
BL: As a leader of one of the largest independent practices in Colorado, I hope we will continue to show growth in physicians. I have regular conversations about all the options that exist and am often told the same things. Hospital employment sounds great early, but ultimately is challenged over the long term by many factors the surgeon cannot control (allocation of resources, PCP referrals, potential for reimbursement to reduce). Private-equity backed groups continue to struggle with how to recruit into a group after the initial private equity investment, when future partners cannot realize the initial benefit. ASC growth will continue, but I do not believe that they will be large employers of orthopedic surgeons. Alignment with health insurance entities through MSO relationships has an opportunity to grow as well.
The factors that are driving these changes are the increased cost of practicing medicine with the continued downward pressure of reimbursement. I would love to see investment into alternative payment models that reward cost containment and quality. If this were to continue to develop, I think that there would be increased opportunities for independent practices to succeed.
