Why doctors are leaving private practice

Doctors are leaving private practice in increasing numbers, with just one third expected to continue working as independent practitioners by the end of 2016, a new study from Accenture found.

The report, "Clinical care: The independent doctor will NOT see you now," found that the number of independent physicians dropped from 57 percent in 2000 to 49 percent in 2015. Accenture predicts that next year this number will drop further, to 33 percent, and represents a 10 percent decline from Accenture’s 2012 report.

Two factors that physicians cited most often as their biggest concern with remaining independent were reimbursement pressures and overhead cost, cited by 36 percent and 23 percent of respondents, respectively. With that, some independent doctors are choosing to opt-out of public programs, such as Medicaid (cited by 26 percent of respondents), health exchange plans (15 percent) and Medicare (3 percent).

"How the physician employment trend and its implications will unfold remains to be seen," the study said. "Other clinical care providers — local hospitals, integrated health systems and even retail clinics — are likely to experience a shift in patient populations, a new payer mix and healthcare delivery challenges as it evolves."

The report said physicians will continue to face a changing landscape for working conditions. Accenture explained that since independent practice is no longer business as usual, physicians must establish a competitive business model unique to their particular market.

“Independent practices need business models that are as unique as the market they serve,” said Kaveh Safavi, MD, global managing director of Accenture’s health business, said in a statement. “There’s increasing complexity with running an independent practice and requires that doctors differentiate by specialty type, size or in personalizing service options, such as remote consultations or same-day appointments. Doing so will help independent physicians stay relevant and profitable.”

Meanwhile, in response to revenue and cost pressures, other independent physicians are experimenting with low-staffing models, such as reducing support personnel (22 percent) or extending office hours (21 percent). 

Independent physicians are also creating new business models to remain competitive. Nearly one-fifth (17 percent) of those surveyed are participating in accountable care organizations and 7 percent are aligning to patient-centered medical home models. In other cases, one-fourth (24 percent) are considering ancillary or subscription-based services to generate new revenue streams over the next three years.