Every day, it seems, there's another headline asserting the inevitable death of private practice. "Why private practice is dying" declares one. "Consolidation continues to surge" announces another. These headlines have a somber yet alluring quality —like perfect tragic clickbait, but are they accurate?
For private practice to die, doctors themselves will have to pull the plug. Not just some older physicians enticed by a shiny buyout offer and not just brand new doctors overwhelmed by student loan debt. For private practice to go away, most physicians will need to believe that practice ownership is no longer a rewarding path, especially as employment opportunities continue to proliferate.
So is that what physicians mostly believe?
Our consulting group, Capko & Morgan, and MedData Group teamed up to try to get an answer. In a nationwide email survey of physicians, we gathered opinions about the prospect of private practice careers. The response was robust: More than 250 physicians in 23 different specialties participated. The respondents ranged in age from recent graduates to physicians who've been practicing for 30 years or more.
The results surprised us and if you've been inclined to believe the gloom-and-doom headlines about the future of private practice, they might surprise you, too. Despite the challenges of going (or remaining) independent, most of the physicians who responded to our survey are still positive about practice ownership. The most telling finding is that it's not just current practice owners who are optimistic. Employed physicians see the upside to private practice careers, too.
Q: Please rate your agreement with the following: Private practices offer physicians satisfying career opportunities.
Among physician owners responding to the survey, 80 percent said they strongly agree or somewhat agree that private practices offer physicians satisfying career opportunities. Even more surprising, 61 percent of the employed physicians strongly or somewhat agreed and only 10 percent of physician owners and 15 percent of employees disagreed.
For many of the employed doctors, they're not just positive about private practice ownership in general; about 20 percent said they are considering owning their own practices in the future. Eight percent said they're planning to start a new practice in the next three to five years.
Now eight out of 100 might not seem like a high proportion in a vacuum, but consider that the Small Business Administration reports that about 1.2 million new employer firms were launched in the U.S. from 2011-2013 – which works out to well under one new firm for every 100 Americans. The expected rate of practice launches among our physician respondents notably exceeds the entrepreneurial activity among Americans as a whole.
Our survey, "Physician Satisfaction with Practice Settings," clearly struck a nerve with respondents. Besides sharing their continuing confidence about private practice ownership, more than half of the respondents took the time to share more detailed, free-form comments.
Not surprisingly, and despite their optimism about private practice careers, physicians voiced some familiar concerns about the threats continue to make it more challenging. Government interference as a factor dragging down physicians' ability to remain independent and profitable was noted by 31 percent of commenters. Pressures from insurance companies (21 percent), profits being squeezed by revenues growing slower than expenses (17 percent), and billing and other management challenges (10 percent) were other commonly cited obstacles to operating a private practice.
Of course, commenters offered reasons for bullishness, too. The ability to control practice policies without interference from non-physicians was a recurring theme. One-in-four respondents suggested this is a key reason private practice still appeals to them; another 8 percent noted that ownership allows physicians to establish better relationships with patients.
This last point is one that deserves more attention. As Bob Kocher, one of the policy writers of the Affordable Care Act, pointed out in his memorable Wall Street Journal column in July, the consolidation that health reform encourages may actually work against the quality improvements the ACA hopes to achieve. Excellent care is what doctors want to provide and practicing independently may be the best way for them to provide it. And if, as one of our respondents said, many of them consider it "the BEST career on the planet," we'll all be better off if the hype about independent practices disappearing is indeed overblown.