Ripley Hollister, MD, has seen the changing wave of practice models in this country from two different perspectives.
As a board member of the Physicians Foundation, a nonprofit physician advocacy group, Hollister has seen it from a pure numbers perspective. In 2016, Physicians Foundation surveyed more than 16,000 physicians and found that approximately 32 percent were independent practice owners, down from 48 percent in the 2012 version of the survey. Conversely, 57 percent of physicians identified as hospital or medical group employees, up from 41 percent in 2012.
Hollister has also seen the shift firsthand as an independent family physician in Colorado Springs, Colo. He can relate to the struggles many of his colleagues went through before going the employed route. "[I'm] struggling to maintain my independence and find my way through the economic morass and the administrative and governmental regulations and narrow networks," he says.
Hollister, who has been employed for a brief period of time when he first moved to Colorado Springs in the early 1990s, says he wants to be independent as long as possible, even weighing a potential jump to direct primary care (DPC) medicine, eschewing payer contracts, to do so. For those with an independent spirit like him, employment is not really an option. However, he admits outlying forces are pushing against his personal desires. For one thing, he wears many hats, to say the least:
As a practice owner, Hollister deals with employee management — hiring and firing, direction and motivation, benefits, retirement, medical insurance. He also deals with the small business issues — accounting, supplies, vendors, workman's comp insurance, facility insurance, making payroll, how much cash he has on hand, negotiation for services, cleaning, lawn care, rent, and ownership.
"Then I have all the other factors that come with dealing with the medical practice — EHR selection, the expense and support of that, standing orders and protocols, medical supplies, and how to interact with government and insurance contracts, as well as [compliance] with the ACA and Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)," Holliser adds.
Most of these are not issues employed physicians have to deal with on a regular basis. As such, Hollister understands why physicians make the switch, especially in an era of tightening regulations.
There's also another factor spearheading this shift from independent to employment. As Marni Jameson, executive director of the Association of Independent Doctors, puts it: "It usually means more money."