Small practice evolution: New models go mainstream

May 2, 2008

A growing number of doctors are dedicated to keeping the small practice model alive. In using innovative strategies to keep solo or small group practices successful, they're stubbornly bucking a trend that's become familiar in recent years.

Between 1996 and 2005, the proportion of doctors in solo and two-physician practices dipped from 40.7 percent to 32.5 percent, according to the Center for Studying Health System Change. During this same period, the Center found, "the proportion of doctors with an ownership stake in their practice declined from 61.6 percent to 54.4 percent as more physicians opted for employment." Reasons for the trend are multiple, but downward pressure on practice income plays a key role.

Yet, small practice owners like being small and reject the notion that bigger is better-or that becoming an employee is a panacea.

Independence is part of the allure. A solo practice, or even a group of two, three, or four physicians, makes it easier for doctors to be their own boss, set their own hours, choose their own staff, and be the captain (at least partially) of their own destinies. They're also happy to be free of the typical corporate hassles-the top-down decision-making, the dictates of an owner or CEO, and the expected or mandatory committee service-that come with larger groups.

These models aren't mutually exclusive-a micropractice can easily be run on a cash-only basis, just as concierge practices can easily incorporate open-access elements, as many already do.

Whether you see all this as a small practice revolution or evolution, we think you'll be interested in the stories-and successes-of these 21st century pioneers.

Open-access model. On the theory that patients should be seen when they want to be seen, open-access practices typically feature same-day or next-day appointments, extended office hours, and, increasingly, virtual visits. Physicians involved in this model say it not only boosts patient satisfaction and improves care but also leads to greater efficiency, happier employees, and a bigger bottom line.

Concierge practice. Doctors who have adopted this model offer a higher level of service than most patients are accustomed to today, in return for a specified annual fee. These physicians like the extended visits with patients, the time to do more preventive care and patient education, and the chance to forge longer-lasting doctor-patient relationships.

Cash-only practice. Seen by some as a subset of the concierge practice, the cash-only group eliminates the need for time-consuming (and costly) billing, third-party collection hassles, and routine paperwork. The payoff: more time to concentrate on patients who pay as they go and collect from their health insurers on their own.

Micropractice. This is a low-volume, highly efficient solo practice that typically relies on cutting-edge technology to keep overhead low and free up time for more doctor-patient interaction.