Not that long ago, in the mid-1980s, more than half the doctors in the U.S. worked independently, and less than five percent were in large physician groups. Now healthcare has undergone a dramatic shift, with only 36 percent of physicians working in a solo practice in 2017. 20 percent of physicians now work in groups of 25 or more and 65% of doctors are based in a hospital.If trends continue, by just 2019, an estimated 75 percent of all new physicians will be employed in a hospital. This is driven in part by the newest generation of doctors, who are 2.5 times less likely than their older counterparts to be in solo practice, and the lack of replacements for retiring solo physicians. Many existing doctors are also enticed out of private practice with buyout offers from hospitals and other healthcare providers. With the number of U.S. solo medical practices declining rapidly, it is time to examine the trend, and see what the advantages might be for a new doctor deciding to go it alone.
Why are There Fewer Independent Doctors?
Medicare Changes
One possible reason for the shift away from independent practice is government regulation. The Medicare Access and CHIP Reauthorization Act (MACRA) passed in 2015, shifting payments from volume to value. With the Merit-Based Incentive Payment System (MIPS) and the Centers for Medicare and Medicaid Services Quality Development Plan (MDP), doctors were forced to prove they were providing efficient, effective, and high-quality care at a reasonable cost. Policymakers believe larger organizations are more effective, more efficient, and more data-driven than smaller practices, so they continue to drive healthcare toward a large-provider model. The newer regulations require additional documentation and administration for doctors to prove their worth, and get paid, whether they tackle this paperwork themselves or hire extra help. For a doctor working alone, that burden might take up a disproportionate percentage of their time, eating away at the time they would normally spend helping patients.
However, in a hospital or large group practice, the burden would be disproportionately less, based on economies of scale. With dedicated employees to tackle the paperwork for all the doctors involved, there would be less burden on an individual doctor to take care of it themselves. Faced with this, many former solo doctors, and newcomers, might opt for the easier route, joining a hospital or larger physician group.
Lack of Business Interest and Management Skills
Some doctors have an entrepreneurial spirit, dreaming of running their own business. Others, not so much. For those who want to focus solely on practicing medicine, the thought of a solo practice can be daunting. As doctors with their own practice know, it can involve plenty of hard work that has nothing at all to do with what they learned about medical school. There is a business to manage, staff to supervise, building maintenance to take care of, marketing to do, medical supplies to order, paperwork, paperwork, and more paperwork. This multitasking may not appeal to every new medical school grad whose education focused solely on perfecting the art of medicine. For these doctors, it may be easier, and more appealing, to join a hospital or large physician group: let someone else take care of the business end of things.
Steady Income and Work-Life Balance
Running a solo practice can be a juggling act. If you fail to devote enough time to marketing, you may not attract enough patients. If you spend too much time marketing, you may not have enough time to see patients. In contrast, with a larger clinic or hospital, there is a steady supply of patients, which means a steady income. It can also provide more work-life balance, often allowing colleagues on the same team to take over if needed for a vacation day or family emergency. For new medical school grads faced with huge student loans, the steady income of a larger clinic can be appealing, reducing some of the uncertainty of solo practice. To those with young families especially, work-life balance is essential. For this reason, many new doctors and existing solo doctors may turn to jobs at larger medical facilities.
Fear of Needing Backup
Some new medical school grads may feel they lack the knowledge and experience they need to care for all their patients. They may be worried they need backup if they are unsure of a diagnosis or are confused by medical billing codes. For these new doctors, it may be more appealing to work in a larger healthcare setting with more senior doctors they can learn from.
Advantages of a Solo Practice
Independence and Control
Although many doctors are flocking to hospitals and large physician groups, some do still see the appeal of running a solo practice. For many, the appeal is independence and control. They enjoy the thought of being their own boss, setting their own hours, hiring staff with compatible personalities, even deciding what color to paint the office walls . . . whatever it is, they are in full control. Especially for the entrepreneurial-minded doctors out there, this remains a driver to set up a solo medical practice of their own.
Patient Bonding
In a hospital or large clinic, patients may come in and out, seeing a different doctor each time. In a solo practice, it is only the one doctor taking care of all their patients. They get to know the patient on a personal level, seeing a familiar face, remembering patient history when a new problem presents, and watching children grow into adults with kids of their own. Some doctors prefer this more personal approach to medicine, seeing the results of their care as their patients grow and thrive.
What Options do Doctors Have for an Independent Practice?
Partner up with Associates
For doctors concerned about the disadvantages of running a solo practice, there are other options besides a hospital or large physician group. Partnering up with associates can help reduce the burden of going it alone while still keeping plenty of independence and control over the medical practice. A small group of physicians can share resources, hiring a shared receptionist, office manager, nurse, and other essential staff. Within a small physician group, one support person can focus on all the regulatory paperwork and billing for everyone, reducing the burden each doctor would otherwise face. With shared office space, there is lower overhead per doctor, and no one doctor is forced to take care of all aspects of running the business.
Concierge Medicine
If the idea of managing an office is a concern, another option for doctors is concierge medicine. Some doctors ensure a steady income by working for patients on a retainer or membership basis. For a flat annual fee, patients have access to VIP perks, such as 24/7 access to the doctor, same-day appointments, longer appointments, and other benefits many more affluent patients are willing to pay for. Many large cities already have concierge dermatologic practices as this relatively new way of doing business grows. Not only do the membership fees ensure a more steady income for doctors, but the appeal of this unique business may save the marketing costs of competing with other solo doctors, offering something to differentiate this practice from the rest.
Some doctors even save overhead by offering on-site services. For example, a dermatologist with a mobile service can take their consultations and cosmetic injections on the road, visiting a patient where and when it is convenient for them. This gives patients a perk while allowing the doctor to save on the cost, and hassle, of maintaining an office.
Telemedicine also has similar potential, allowing patients to access their doctor where and when they need it. With this technology, a patient may be able to reach their doctor in a small home office, again saving the time and hassle of maintaining a public-facing office.
Should You Set Up a Solo Practice?
Ultimately, the decision to set up a solo practice is up to the individual. Some may thrive as an entrepreneur, while others may find it daunting; some may like control everything themselves, while other may enjoy letting others take care of the paperwork and other day-to-day aspects of running a business. Although solo practices are on the decline, it does not mean the demand from patients is lacking. There is still plenty of space for doctors to carve out their own niche in healthcare, bringing their patients the service they need.
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