Survey Says: Independence Trumps Hospital Employment
By Lea Chatham
There has probably never been as much uncertainty about the future of healthcare as there is right now. On the heels of the release of the MACRA final rule came the unexpected results of the presidential election. The President-elect has made it clear that he will make changes to the Affordable Care Act, which has been the law of the land for nearly eight years. And MACRA solidifies the industry shift away from fee-for-service to value-based care.
It might seem like with all these challenges, independent physicians would be looking to shift to employment, but the opposite seems to be true. There actually appears to be a slowdown in employment as physicians look for ways to stay in independent practices.
According to the AMA, only 33 percent of physicians currently work in hospitals or hospital-owned practices. The other 67 percent are in private practice, with 60 percent in practices of 10 physicians or less. Half of the physicians in private practices are owners or co-owners of the practice. While that means the other 50 percent are employed, they are working in private, independent practices, and they do find that more satisfying than hospital employment. A recent survey from MedData Group showed that 80 percent of physician owners and 61 percent of employed physicians strongly or somewhat agree that private practices offer satisfying career opportunities.
That same study also showed that 20 percent of employed physicians are considering owning their own practice in the future. This makes a lot of sense when you consider that self-employed doctors have higher satisfaction then employed doctors, according to Medscape. The same survey also showed that 71 percent of doctors said their work satisfaction improved when they left employment.
And it turns out that the physicians who are already owners or co-owners are loathe to sell out or close. Seventy-three percent of practice owners said they would prefer not to sell their practice. Seventy-two percent of practice owners said they envision a significant number of physicians who have been employed returning to independent practice.
“We have seen this trend firsthand,” says Kareo CMIO Tom Giannulli, MD. “In 2015, 15 percent of our new customers were starting new independent practices, and that has remained steady.” He adds that a recent survey of customers about MACRA showed that 85 percent are planning to participate to the best of their ability and only 2 percent are planning to speed up retirement or close or sell their practice. “What this tells me is that they are willing to tackle the challenges to stay in private practice,” he explains.
Giannulli has also been watching a growing trend of independent practices testing alternate payment models, which he attributes to their ability to be more agile and flexible in the way they practice. The 2016 Practice Models Perspectives survey, sponsored by the American Academy of Private Physicians, showed that 25 percent of physicians are already using some form of concierge, direct pay, or membership model in their practice; and another 35 percent are interested in trying something like that as well. The most striking finding of the survey was that most practices testing these models are not making a complete change. Only 30 percent are using a direct pay or membership model with all of their patients. The majority are using these models with only a portion of their patient population.
“They are trying out these options to see how they work and if they help reduce health plan and government program challenges,” says Giannulli. “The survey also showed these practices were more likely to be trying telemedicine and looking to potentially increase virtual visits.”
The nature of smaller independent practices makes it easier to try new payment models, test out new technologies, and either keep moving if it works or try something else if it doesn’t. Considering this and looking at all the latest trends, we may actually begin to see the slowdown turn into a reversal with more physicians choosing independent, private practices over hospital employment in the coming years.
Lea Chatham is an editor at Kareo in Irvine, CA.