The increasing burden of private practice

In current economic times, many doctors are selling their practices to larger groups or hospital systems. I have heard it estimated that in the next few years, only 30 percent of doctors will remain in private practice. The burden of running the business of a practice while keeping up with the latest medical technology has just become too much for many physicians.

In general, the cost of living has greatly increased over the past decade. But overhead costs for medical practices have skyrocketed. From EHR vendors to those who sell exam room supplies, companies are continually angling for a bigger share of healthcare dollars.

Meanwhile, in my 15 years of private practice, I do not recall my reimbursement rates from health insurance companies rising once. Likewise, many doctors are on the same reimbursement schedule that they were a decade ago.

If you combine those factors with cost-of-living increases and expanding overhead expenses, some doctors are just not able to stay in private practice financially. This is perhaps the biggest cause of doctors selling out to others and becoming employed.

Another big push away from private practice is bearing the brunt of all the new regulations being hurled at us. We now need to comply with meaningful use and PQRS reporting requirements or pay penalties in our reimbursements. In my practice, we did certify for both steps of stage 1 MU. However, it required dedicating one of my staff full-time for several weeks to collect all the data that needed to be reported. Many practices do not have IT departments or extra staff on deck. We cannot call up temps when we have a staffing shortage. It ends up being very costly and time-consuming for doctors in private practice, especially in small groups or solo. Plus, being short-handed disrupts the whole workflow of the practice. Additional pressures come from qualifying as a patient-centered medical home to take part in value-based care initiatives. 

Not only do most doctors not have the time to deal with all this, many of us do not feel that these mandates are useful for clinical practice and there is no evidence that they improve patient outcomes. We feel enslaved to useless regulations and feel much of the power of practicing medicine has been taken out of our control. Many doctors are just giving in and giving up the control of running a practice.

Admittedly, there has always been a lack of work-life balance among physicians, but this seems to be worsening. For instance, many doctors feel that EHRs are keeping them in the office for longer hours in order to be able to chart all the metrics required for MU. I personally leave the office many nights after 9 PM with my charts undone. I have spent many Saturday evenings and Sunday afternoons just charting. This lack of time for activities outside of medicine is leading to a high burnout rate among physicians. Many are choosing to retire earlier.

In my opinion, when doctors are in charge of running their own practices, patients receive the best medical care. When decisions come down as to what formularies need to be followed, some of the decision-making has been taken over by third parties outside of the exam room. Additionally, doctors are the ones with their feet on the ground treating patients and are in the best position to determine what is needed to establish the optimal work environment that enables improved patient outcomes.

We need to have a return to private practice rather than the exodus that we are seeing. More physician voices need to be heard to make mandates and practice issues reasonable and manageable. Unless that happens, private practices will have a hard time surviving, and that will be at the great detriment of doctors and patients alike.