The Physician Shortage, Part Two: Keeping the Doors Open with Concierge Medicine

In Part One, we described the role concierge medicine plays in extending the active years of experienced, dedicated doctors and helping to significantly ease the looming physician shortage. Now we consider how concierge medicine has sustained the practices of independent primary care physicians who are rapidly becoming a vanishing breed in the U.S.

Among the pandemic’s many heartbreaking statistics is this one: In 2020 and 2021, more than 24,000 independent practices were reported permanently or temporarily closed. We now have an even clearer picture of the pandemic’s impact on private practitioners with new data from Avalere and the Physicians Advocacy Institute (PAI) showing that almost three quarters of U.S. doctors now work for hospitals, health systems or corporate entities. That represents an almost 20% jump since 2019.

"COVID-19 drove physicians to leave private practice for employment at an even more rapid pace than we've seen in recent years," according to Kelly Kenney, chief executive officer of PIA. ”This study underscores the fact that physicians across the nation are facing severe burnout and strain. Between the financial stress that the pandemic had on practices, because they certainly had little revenue for a while, and the stress that physicians have felt mentally, you can't overstate that."

While a sense of normalcy is thankfully returning to everyday life, for primary care physicians in traditional fee-for-service practices, the situation remains bleak. According to the most recent Primary Care Collaborative survey, more than half of physician say primary care is crumbling, over 40% report describe themselves as mentally and financially fragile, one third report they are currently denied and/or seriously overdue payments from insurers and health plans, and only 21% find the fee-for-service form of payment sufficient.

We have long understood that the traditional fee-for-service payment model is simply not sustainable. Consider that since 2001, Medicare physician payment has fallen 20%, adjusted for inflation, while the cost of running a medical practice has increased 39% in that same time period. Becoming a hospital-employed physician doesn’t provide a neatly packaged solution either. As reported in a recent Forbes article, after acquiring a physician practice, prices for healthcare services increase by 14% and hospital revenues rise by nearly 20%. However, most physicians are not benefiting, but are in fact, earning 20% less than independent practitioners, according to a 2022 Medscape survey.

Most troubling, as a result of the myriad challenges with seemingly no end, 25% of the physicians surveyed by the Primary Care Collaborative expect to leave primary care in the next three years. A December 2021 AMA survey also reported that one in five physicians said they would likely leave their current practice within two years. The impact of this physician exodus is an incalculable loss that will be felt for many years to come.

However, for concierge medicine physicians, while the pandemic was difficult and demanding, their professional survivability was never in question. A stunning zero percent of concierge medical practices were closed during the pandemic, and they continue to thrive in 2022, based on a solid foundation of revenues driven by membership fees. Freed from financial worries and overloaded patient panels, concierge physicians not only keep their doors open, but their minds and hearts as well.

At Specialdocs I am gratified that we are able to offer a remarkably effective solution with proven resilience throughout two decades of relentless change. Below is a sampling of comments from our physician clients who sustained their practices and restored their passion for patient care with a thoughtful transition to our membership medicine model.

Dr. N.M., Atlanta, GA: “Before I made the change, I was burned out to the point where I knew I was done with medicine if this didn’t work. I was so frustrated with the way things had continued to worsen over the last 15 years - I didn’t want to end up like the proverbial lobster in a pot of gradually heated water that doesn’t realize it’s being cooked until it was too late. Now I have a completely different practice and life and I can’t imagine ever going back to the way things were.”

Dr. M.S., Burbank, CA: “My traditional practice had grown to the level where I was responsible for almost 4,000 patients and I was drowning. Appointments were always rushed and there was never enough time. I felt that it was inevitable that I was going to miss something or make a mistake and neglecting my personal health and family life was the price I was paying.Concierge medicine was, and still is, the best way to achieve a work-life balance that is rarely seen in a primary care practice.”

Dr. I.K., Petoskey, MI: “Despite surging demand for rheumatology specialty care, my private practice had become too challenging to sustain. The paperwork and administrative burdens for a solo rheumatologist had mushroomed in the last decade, requiring an inordinate amount of time for prior authorizations, step therapy and electronic health record documentation; concurrently reimbursements continued to decline. I recognize that while it may not be the answer for every doctor, changing to the concierge medicine model with Specialdocs was the only viable alternative to permanently closing my practice doors. It has proven to be a tremendous fit for my career. Patients are now able to get an appointment the same or next day. We have unrushed visits that are conducive to incorporating beneficial integrative medicine modalities such as dietary, exercise, and mind-body approaches as appropriate, in addition to state-of-the-art treatment. I also have more time to coordinate care and give patients prompt feedback on lab and study results. From the first night of transition, I was able to sleep well, knowing my patients were being better served, my staff was happier, and that I could continue to practice in a time of great change and challenge for rheumatology.”

Dr. Z.C., Nanuet, NY:“My change to concierge medicine early in 2020 was precipitated by years of practicing like a hamster on a particularly relentless wheel, seeing up to 40 patients each day, with non-stop calls and endless paperwork afterward. Among several, mostly unpalatable options, including employment by a hospital, grinding it out until retirement or leaving the profession altogether, only the change to a concierge medical practice offered a workable solution for me. Had I not begun my concierge practice shortly before the pandemic started, I would have been totally unprepared to face an empty waiting room and a dramatic drop-off in office visits. Even more importantly, my patients would not have received the unlimited time and attention I was profoundly thankful to provide.”

Dr. B.B., Brookline, MA: “Making the change to concierge medicine saved our entire organization, including many who had worked with us for their entire careers. In 2020, it became increasingly clear that the pandemic was going to result in our shuttering the practice. I was compelled to find a way to reinvent ourselves and preserve the practice we had built with the utmost care for more than 25 years. Our transition with Specialdocs allows us to offer an approach that benefits patients enormously with time to focus on non-invasive treatments, prevention and wellness…and has restored our joy in practicing medicine.”

Terry Bauer is CEO of Specialdocs, a concierge medicine pioneer that has transformed physicians’ professional lives since 2002, empowering them to deliver personalized patient care