Can Solo Physician Practice Survive?

I can remember walking to elementary school and passing several solo doctor offices with a shingle hanging on a post in the front. They were usually modest offices in the ground floor of another residential building or store front and they served as a convenient community resource. Most were solo general practitioners who had affiliations with community hospitals if you needed inpatient care. Now, shingles are relics of a bygone past and, rather, are more likely to be seen on a direct-to-consumer advertisement, trying to convince you to get vaccinated against the disease if you had chickenpox.

I was a solo practitioner otolaryngologist (ear, nose, and throat surgeon) for several years of my career.

But, the numbers don't look good. In 2014, only 17% of physicians indicate that they were in solo practice, down from 25% in 2012. As medicine gets more complicated, market forces are changing and residents are choosing employment with consolidating integrated delivery systems, is there a future for solo medical practice? It depends on:

1. Whether physicians practicing as solo technicians can reposition themselves as solopreneurs.

2. Whether we unbundle primary care.

3. Whether the rules change to relieve private practitioners and solopreneurs from onerous and costly third-party and government mandates.

4, Whether solopreneurs practice Othercare instead of Obamacare.

5. Whether inexpensive, turnkey business process outsourcing models are created to supply solopreneur networks.

6. Whether new primary care business models are created to consolidate to build market clout.

7. Whether solopreneurs adopt eCare technologies and have the support of rural communities to help them thrive. For example, the use of virtual health tools in primary care could save nearly $10 billion each year, according to a new report from Accenture.

According to the report, digital tools — including biometric devices, analytic diagnostic engines and virtual medical assistants – can help streamline work and allow clinicians to focus on high-value tasks by:

• Automating tasks;

• Replacing labor with technology; and

• Shifting tasks to patients

• The report said that virtual health tools can save time and money when applied to:

• Annual patient visits;

• Ongoing patient management; and

• Patient self-care.

8. Whether the medical education establishment eventually understands that solo practitioners are an important part of the national Sick Care ecosystem and, in many instances, fit the unique needs of the communities they serve and need the business skills, knowledge, and attitudes necessary to thrive.

9. Whether there is pushback against the increasing corporatization of medicine.

10. Whether the changing demographics of the physician workforce (younger women and older men) see solo private practice as an option to continue practicing as part of the sick care gig economy in local co-working spaces for doctors

Solo private practice as it is presently practiced has a gloomy future. Recreated, solo practitioners can thrive.