Many more physicians have moved from private practice to working as employed physicians over the last several years.

As Walker Ray, MD, vice president of The Physicians Foundation says, "America's physician workforce is undergoing significant changes. Physicians are younger, more are working in employed practice settings and more are leaving private practice" but "…these trends carry significant implications for patient access to care," Ray adds.

He fears that, "…with more physicians retiring and an increasing number of doctors, particularly younger physicians, planning to switch in whole or in part to concierge medicine, we could see a limiting effect on physician supply and, ultimately, on the ability of the US healthcare system to properly care for millions of new patients."

New figures from management consulting company Accenture suggest that just one-third of US physicians will remain independent by the end of next year. Their new report shows that the number of independent physicians fell from 57% in 2000 to 37% in 2013, and is predicted to fall to 33% by the end of 2016.

Private Practice

"The era of the independent physician that many adults grew up with is swiftly coming to an end," the report states. "Independent physicians are not only declining in numbers, they are also changing their business models."

"Independence is not easy," it adds. "Today's independent physicians face the same disruptive market conditions that have led many of their peers to sell their practices or seek employment directly with health systems in recent years. Many physicians who remain independent are changing their business models to respond to changing market demands."

In addition to healthcare market dynamics, the reasons for this change include altered physician preferences. Residents and new physicians were asked their opinions on private practice versus employed physician work in a survey by Jackson Healthcare. This survey found that 42% of physicians chose hospital employment over private practice because they "…did not want to deal with the administrative hassles of owning a practice". Other reasons included wanting to "be a doctor not a businessperson" (32% of respondents), better opportunities in a hospital (28%), and not having the money to invest in a medical practice (27%).

Jackson Healthcare President Shane Jackson commented, "This trend toward employment has been several years in the making, but what we are seeing with this generation of young physicians is that most want to do what they went into medicine to do - to take care of patients - and then they want to go home and be with their families." Some, however, believe there is hope for the future of private practice, with a possible levelling off in the rate of decline. One factor that may encourage physicians to remain independent is the rise of new practice models such as the patient-centered medical home (PCMH) model of care. Its guiding principles involve a physician-led practice with "whole-person orientation", meaning that the care team provides comprehensive care, including acute care, chronic care, preventive services, and end-of-life care, at all stages of life.

PCMHs integrate and coordinate care by ensuring patients receive the services they need from the medical neighborhood, with an additional focus on the quality improvement process and enhancing patient access to care. At present, most practices are not required to complete a recognition program for PCMH, and recognition is voluntary. This is one avenue by which physicians can organize care to meet patients' needs in a novel way - recognizing that patients, providers and insurers are must all work together to meet patients' needs and enhance vital preventive care efforts.

For many physicians, the flexibility and freedom aspects are considerable advantages of independent practice. It remains to be seen how far the trend toward employed models will increase over the next few years.

References:

The Physicians Foundation and Merritt Hawkins. Survey of 20,000 U.S. Physicians: 80% of Doctors are Over-extended or at Full Capacity. September 16, 2014.
http://www.merritthawkins.com/uploadedFiles/MerrittHawkings/Clients/2014_Physicians_Foundation_Merritt_Hawkins_Release(2).pdf

Accenture. The (Independent) Doctor Will NOT See You Now. 2015.
https://www.accenture.com/t20150608T044420__w__/us-en/_acnmedia/Accenture/Conversion-Assets/DotCom/Documents/Global/PDF/Dualpub_15/Accenture-The-Doctor-Will-Not-See-You.pdf#zoom=50

Jackson Healthcare. Filling the Void: 2013 Physician Outlook & Practice Trends.
https://www.jacksonhealthcare.com/media/191888/2013physiciantrends-void_ebk0513.pdf

American Academy of Family Physicians. The Patient-Centered Medical Home (PCMH).
http://www.aafp.org/practice-management/transformation/pcmh.html

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