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Autonomy vs. Employment: Concierge Care Can Help Physicians Decide


Joining a large group is tempting; but it may lead to less autonomy and in years to come, greater risk. Concierge programs can help offset loss of independence.

If you are an independent physician who either makes the decisions about how your practice is run or how, as a group, your group is run (small to mid-sized groups), then you have some degree of precious autonomy. Outside of in-network considerations, you have some control over who you direct your patient to for additional services and other physician care. You also have some say in the style of care that you deliver. The downside can be, however, that over time larger groups have gotten better reimbursement rates from private payers. As a result, you have a disadvantage that is significant. And larger groups are often better at employing IT solutions and support services. So why not consider selling or merging now?

The answer is simple: You give up the control that you have. And the care that your patients receive may no longer be the same. It has been our experience that every physician who makes the move to a hospital-based employed physician environment is initially happy. The old burdens of running a practice are partially and in some cases completely removed. After a few years where there may be some guarantee of income, it turns into an "eat what you kill" environment, the same one that you probably came from, except now there are now much higher overheads associated with the "management" of the practice. Nothing is for free. In some instances the revenue differential is sufficient to overcome the negatives, but usually this is not the case. And the pressure to see more and more patients grows even stronger in this environment. Or it may be that you send more and more patients to mid-level providers. Sometimes this is good and sometimes not.

So what can you do differently? Oddly enough, more and more systems and larger groups are comfortable with concierge programs. The comfort level is much higher with a hybrid model than a full model, as it is much more compatible with their volume needs and the strategic goals of a group. Many groups have acquired physicians who are concierge doctors and their enhanced revenue makes them better candidates in the acquisition. The take away here is that if you are thinking about acquisition, a hybrid concierge program adds value to your practice or group practice as it adds revenue and does not reduce the productivity. Concierge programs increase the connection to your patients and makes transitions to a system a bit easier.  Your concierge program can be a great asset when merger negotiations are underway.

As far as the decision to merge or not, with over 53 percent of physicians still practicing in independent environments, it’s clear that not everyone will make the move.  It is a decision that must be weighed carefully.  

I have not heard from anyone who has made the change, and in the long term, are glad they did so. It is a tempting choice, as it is certainly harder and harder to just be a physician and not a wiz at technology, law, and roller skates. Just remember, the grass is not always so green on the other side.  Even the economic benefit of higher reimbursement rates will eventually be gone as the risk-based delivery programs become more and more a part of the delivery of care.

But whatever you decide is right for your practice, moving to concierge programs could be helpful, regardless of the decision.

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