Thirty-five year old James Pinckney II, MD, founder and CEO of a family medicine practice, Diamond Physicians, Dallas, Texas, says he wanted control over his life as he began his career. "As an employed physician, you have production requirements; I didn't want to follow that model," he says. Like Briggs, he started his practice upon graduation. He has found that direct primary care (i.e., an alternative payment model requiring a flat, membership fee) makes billing very simple. The model allows him to spend more time with patients compared to employed physicians who accept traditional insurance.
Owning your own practice has other perks as well. "I decide how many patients I see and how to provide the best care for them," says Briggs, who has practiced for eight years. "I am in charge of office protocols, hiring, and firing. I am not subject to the actions of a non-medical administrative board when caring for patients."
Reversing the Trend
Experts say one component to getting more physicians interested in starting their own practices is education. "More needs to be taught about the business of medicine at the medical school level and through residency," Singleton says. "A top complaint among providers was that they didn't get an adequate education in this area."
However, Stratos Christianakis, MD, program director, Internal Medicine Residency, Huntington Hospital, Pasadena, Calif., says altering curriculum would be a difficult task considering the variability in regional job markets and public policy changes regarding healthcare. Plus, "adding another dimension to medical education may encroach into valuable time training residents," he adds.
Davis, who finished residency in the 1990s, points out that some residencies have been trying to incorporate business training into their curriculum for decades. "Although well intended, it is almost always inadequate, at least in part because most faculty have limited private practice experience. I only learned myself through mentoring from my former partners," he says.
Davis notes that the economic opportunities for young primary-care providers just out of training are greater and more diverse than ever before, and include direct primary care, micro practices, telehealth, and online locum tenens matching sites — which could play a role in reversing the trend.
"The 'gig economy' is hitting medicine in a big way — and with much lower overhead per opportunity than I ever enjoyed," he says. "Intentionally or not, training doesn't provide exposure to these employment alternatives. With a medical license and a reasonable business plan, banks are more than happy to advance the capital needed to finance student loan payments as individual clinicians' ramp up these low-overhead options."
Fewer regulations could also entice physicians to open their own practices. “Compliance takes time and money,” Dr. Davis says. “The fewer the regulations, the more money a physician has to work with and the more time he or she has for patient care. And the more money a physician can generate, the fewer patients they will need to see to reach their financial goals.”
The bottom line is that much of the stress physicians face today stems from payment systems that force them to take care of far too many patients. “Fewer regulations would allow physicians to take better care of fewer patients,” Dr. Davis concludes.
While there are lots of reasons why physicians aren’t pursuing independent practice nowadays, doing so still has some advantages and new practice models exist. Consider the options as you make your next career move.