As we commemorate our country’s long-ago fight for freedom this Fourth of July, it’s an appropriate time to recognize the more subtle battle being fought to preserve physician autonomy in our country. In a landscape that’s come to be dominated by health systems and physician-employed models, caring for patients in an independent practice is rapidly becoming another victim of the big box era.
In 1983, 76% of doctors were self-employed. Today, according to the Physicians Advocacy Institute (PIA), almost three quarters of U.S. doctors now work for hospitals, health systems, payors and other corporate entities. While the healthcare industry has been inexorably moving toward this outcome for some time, the pandemic unquestionably accelerated it into fast forward mode. For instance, in the past three years, PIA reports an 11% increase in the number of hospital-employed physicians. Digging deeper into the data only points to the strength of the trend, as the majority of doctors employed by hospitals are under the age of 40.
I’m not suggesting we turn back the clock or pursue models that may no longer be sustainable in today’s volatile medical environment, which is still recovering from the impact of COVID-19. But I am urging all involved in healthcare to consider what’s being lost by abandoning the privilege of practicing independently.
“I fear what will happen to the healthcare system when insurance companies have free reign and hospitals/large organizations are making guidelines for patient care. No one will care for patients like a solo doctor will. My patients are like my family. Private practice may be in the decline, but we never needed caring people more.” – Linda Girgis, MD, Editor, Physician’s Weekly, 5.2.22
There is much at stake in recognizing and rewarding the enormous value of this type of care before it disappears irretrievably. It’s why we believe so fervently in our company’s work to transition independent practitioners to the concierge medicine model as a genuine solution. The effect is exponential, with tens of thousands of patients of our Specialdocs physicians reaping the benefits of personalized care each year, a number that continues to rise.
“If you want to be a primary care physician today in a traditional fee-for-service model, you have to limit the time you’re seeing patients so you see enough people in a day that the employer will keep you on. I need to guide my patients through the stages of their lives in a way they feel I’m marching in step with them. With concierge medicine, I can pursue my passion without worrying my livelihood or family will be harmed. I’m able to be patient-focused now and I never would have been able to say that before.” – Adam Rubinstein, MD, Specialdocs concierge physician
Lack of autonomy is a major contributor to physician burnout, still reported at unacceptably high levels of 48-51% for those in family practice or internal medicine in the most recent Medscape survey. Even the most well-intentioned programs to address burnout can’t work without that crucial element, which acknowledges each doctor’s driving desire to choose how to care for their patients and for themselves. It’s not surprising that the survey also showed solo doctors in an office-based practice setting were significantly less likely to experience burnout than colleagues at hospitals or healthcare organizations.
For an independent concierge physician, the differences are profound. They are free from the need to supply endless documentation, concerns over lower reimbursement rates and the ability to meet overhead expenses, and the steady drumbeat of worry over ever-increasing, superficial patient visits required to meet basic income needs.
As a long-time advocate of concierge medicine, I’ve seen how the membership model opens previously shut doors by restoring the time for physicians to pursue personal passions, whether that’s exploring advanced research and promising new technology or mentoring the next generation of doctors. Most importantly, a concierge physician has the opportunity to attain an exceedingly rare work-life balance, becoming immeasurably enriched by time spent with partners, family, friends and community.
Our Specialdocs clients, like many who choose concierge medicine, are a fiercely and proudly independent group of physicians who frequently use words like “grateful,” “joyful” and “rejuvenated” to describe their post-transition mindset. This Fourth of July, we celebrate the reason we established Specialdocs 20 years ago, and what will always define our path going forward: preserving a physician’s right to practice medicine inspired by their own deeply felt vision of care.
A happy Independence Day to all!