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Do America's Doctors Want Their Independence?


My observation was that my father's internal medicine practice was largely successful - for the doctors and their patients. Today's times are different for sure, but whatever the structure of medicine's future, the need for a satisfying doctor-patient connection is as vital now as it ever was.

“To find yourself, think for yourself.”


My doctor-dad was certainly an “independent physician.” He and his brother-in-law practiced as a 2-man medical team for some 25 years and then dad was a solo practitioner for another 15 years (after Dr. George Sheehan took off to pursue his running career).

My observation was that their internal medicine practice was largely successful—for themselves and their patients. Today’s times are different for sure, but whatever the structure of medicine’s future, the need for a satisfying doctor-patient connection is as vital now as it ever was.

I don’t know if dad’s style of medical practice is a dying art, but I’m sure glad to hear that many doctors really don’t want to see it to go away. According to a recent report by ProCare Systems, the 2015 Independent Physician Outlook Survey, about 3 out of 4 specialist physicians questioned would prefer to practice medicine independently if, and this is the giant if, “they could be assured of practice profitability and stability.” Therein lies the challenge.

Dr. Fred Davis, co-founder and president of ProCare Systems, offered some interesting thoughts on this important matter: “As the economic and regulatory landscapes shift under their feet, independent specialists and smaller physician groups face unprecedented uncertainty,” said the 1977 graduate of Chicago’s Rush University College of Medicine. “Revenue lifelines are being squeezed from every direction. Securing payment for their services becomes more difficult every year, while referral streams have come under the nearly exclusive control of big hospitals, insurance providers and health panels. Their practices also face relentless cost pressure as regulators and private insurance giants continue to pile on complex administrative tasks.”

However “as payment incentives shift from a volume model to one built around value and patient outcomes, smaller physician groups, with their agility and natural inclination toward innovation and efficiency, are well-positioned to seize market share in an increasingly consumer-driven marketplace,” said Dr. Davis, who is a pain management specialist. “This could not only help small practices remain independent, but help others reclaim their independence as well.”

Here are some more points from the report to consider:

• In theory, most doctors (73%) want to be independent practitioners; in practice, nearly 45% said they plan to sell their business before the decade is out.

• The 2 biggest obstacles to doctors maintaining work independence are declining reimbursements and raising costs.

• Physicians said the chief factor in their ability to maintain independence going forward is the “specialized nature of their practice within a local healthcare community.”

• Nearly 90% of doctors said that their future compensation depends on the ability to find the right balance of “quality care and cost management.”

• More than 90% of doctors said that “whole person care” (ie, patient engagement, personal preferences and values consideration, preventative care, and wellness) will be a major component of future medical practice.

• About 95% of doctors are tired of the status quo and are eager to see “new practice models to ensure independence and sustainability for the new healthcare economy.”

• The top preferred medical practice model for those surveyed were Independent Practice Associations (IPAs). This being “a loose strategic alliance relationship where there is no equity participation but, rather, a focus on increased size scale for negotiating with payers and larger organized systems of care.”

• More than 70% of those surveyed said that “the natural ebb and flow” of business will permit doctors who are employed by large healthcare institutions to migrate back to independent practice.

• The reports concludes with the statement that a “self-reliant nature and optimistic outlook remains intact” for physicians. They’re going to need it.

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