From the pros of independence to the cons of less financial stability, private practice can be a divisive topic among physicians and executives.
Four physicians and healthcare executives recently shared some of their thoughts on private practice with Becker's:
"When we are having physicians join our group that were previously in employment programs and with health systems, they feel, in many cases, the frustrations around not being able to have a little bit more control around clinical care decision-making and also around being able to be involved somehow in the decision-making of the operations of the practice. Whereas in private practice, that's the opposite. We are physician-owned and physician-led. We have a board of physicians, and they are the executives that make decisions. As a CEO, I'm really looking for more from the operations business, the finance angle, to make sure the institution is viable and growing and doing all the right things. But in the end, the physicians are the ones that call the shots." — Alejandro Fernandez, CEO of San Diego-based Synergy Orthopedic Specialists.
"Physicians remaining independent are going to be few and far between. They're either going to go with these large equity groups or hospitals or something like that. You still have a quote, unquote, "private practice," but you have guidelines and rules that you have to conform to so it meets their criteria. So right away, you feel a little bit of your autonomy being compromised, and then the bigger the group gets, the more restrictions they have on what you can do to stay in the group and conform to what they want you to do. On top of that, the government throws in their regulations too. The private practitioner is a dying breed." — Sheldon Taub, MD, gastroenterologist at Jupiter (Fla.) Medical Center.
"Unfortunately, CMS continues to focus on cuts to the front-line providers for Medicare recipients. I am certainly cognizant of the general financial pressure on CMS and Medicare, but fulfilling their promises on the back of the providers is problematic. These cuts continue to undermine physician practice's ability to provide access and care to the Medicare population. Physician service payments have not come close to keeping up with inflation for years. Indeed, physician payments via Medicare are one of the only areas in Medicare payment models that does not have inflationary adjustments and has had frequent cuts.The staff, equipment and supplies we have in an office practice have continued to go up and are affected by inflation as is everything generally in society. My biggest concern over time is that this will begin to erode access for Medicare recipients to find physicians who will continue to accept new patients or will limit the number of patients from Medicare that they will see. The financial strain on practices will erode development of new services, expansion of care and may influence decisions to join an employment type of practice. Physicians in private practice, despite these cuts, over time have generally improved and expanded the number of patients they serve and take care of due to diligent work, efficiency and innovation. Unfortunately, these financial constraints may ultimately negatively impact our ability to continue to practice as we know it." — Stephen Amann, MD, gastroenterologist at Digestive Health Specialists in Tupelo, Miss.
"It is a lot more about compliance in the corporate world. In a private practice, you're focused on being nimble and making decisions every day. You can look at things and say, 'We can do this better, why don't we do it this way.' You're constantly striving to be better and to be more excellent. The corporate world looks at it like, 'We're doing this pretty good, Let's not mess with it. It's good enough.' And people are more worried about even voicing an opinion in the corporate world. Everybody's always looking over their shoulder." – Michael Gross, MD, orthopedic surgeon based in Hackensack, N.J.