Going solo

How private practices can succeed in the current health care climate

Although today’s private practices face many challenges, many are thriving due to the increased flexibility that comes with being independent, among other factors.

Clifford Stark, DO and Daniel Savarino, DO

Clifford Stark, DO, is a board-certified physician with dual certification in sports medicine and family medicine.

Daniel Savarino, DO, is board certified in family medicine and sports medicine and is RMSK certified in musculoskeletal ultrasound.

Contact Dr. Stark
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With the increasing widespread dominance of corporate America, we all have in some way witnessed the dwindling existence of “mom and pop” businesses across virtually all industries, including service, products, food, hospitality and others. While it’s hard to argue against the many advantages of this trend (standardization, quality control, increased access/availability/supply, etc.), most of us in some way or another miss the general feel of having a greater presence of small businesses, including privately owned practices. 

Health care has taken a similar direction. Privately owned practices continue to be acquired by larger institutions (hospitals, health systems, private equity firms, etc.) and fewer and fewer new private practices are opening.

So what are the challenges that threaten the existence of the privately owned practices that remain—and what factors are enabling these practices to continue to thrive (and even embolden others to open their doors) during these times?

Let’s start by discussing a few key advantages enjoyed by corporate or institutional health care models. Given their sizable market share, they are better able to:

  • Negotiate excellent rates with insurance carriers, along with other benefits such as “shared savings” programs.
  • Make staffing solutions and human resources more accessible and likely provide more favorable employment packages.
  • Provide access to in-house resources such as marketing, IT and legal support.
  • Handle facilities and operations management on a larger scale.

Advantages of privately owned practices 

So how does the entrepreneurial private physician office model compete? First, some patients prefer the overall feel of the private practice model, which in many cases can allow for a closer relationship with the physician and office staff. An analogous situation is the independent local pharmacy, where patients are greeted by a pharmacist who knows them and offers counsel on their issues, providing a personal touch.

Related

Another advantage of privately owned medical practices is the physician owner has more freedom on many levels with tighter control of operations. Those involved in making major and minor practice decisions and policy changes are typically onsite and are usually intimately familiar with the surrounding circumstances and have a better pulse on all aspects of the practice. Decisions can also be made more swiftly and nimbly in response to suggestions by owner(s), providers, staff and patients. 

When it comes to services and products offered, private practice providers have the freedom to choose whatever they feel is appropriate and would best benefit patients, often including cutting-edge services and products. Also, a shrewd owner or office manager can utilize some of today’s improved technology to streamline the process of providing high levels of care in the most efficient and affordable manner. Examples of this are highly sophisticated and user-friendly EMRs, elaborate patient portals and other patient engagement platforms, remote monitoring platforms and more. 

Private practice hybrid

Given some of the irreconcilable challenges facing private practices today, such as lacking significant leverage when negotiating reimbursement rates with insurers, there are some hybrid-like private practices that join networks. As a result, they are able to provide comparable fee schedules and other benefits negotiated by a larger pool. One example is an IPA (independent physician association), which will need to be discussed in a separate article. But there is certainly a spectrum when it comes to degrees of medical practice privatization. 

There are many challenges facing those who own or desire to own a private practice, and it is not a good fit for everyone. Further, many corporate models are striving to emulate the private practice experience in appearance and feel. But for those who are motivated by operating a private practice and not afraid of taking some personal risk, there are many opportunities for owning and building a practice.

Editor’s note: The views expressed in this article are the authors’ own and do not necessarily represent the views of The DO or the AOA.

Related reading:

As the number of private practices shrinks, opportunities exist for ambitious physicians

Getting started in private practice 

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3 comments

  1. J.S. DeWeerd, D.O.

    I would also direct our peers to the ever-growing movement towards Direct Primary Care (DPC), and ultimate freedom from “corporate medicine”. This model is rapidly growing, and taking the insurance companies, including CMS, out of the equation. Having had enough of being marginalized by the “suits” in the hospital administration, I took a leap of faith into private practice. This was a refreshing jump, and I am able to provide a level of care that I could not while being under the “employed physician” umbrella. I have been in private practice for 8 years and I can not fathom going back to an employed physician in a hospital system. The next step for me would be to find a way to dump the insurance companies, CMS and all of the absolutely frustrating hassle associated with these entities. The solution for that would be to go to DPC and provide affordable, complete primary care. This model rejuvenates and maximizes the physician-patient relationship, and minimizes/eliminates much of the bureaucratic b.s. that we currently deal with on a daily basis.

    Reply

    1. Dr DO

      So your practice is cash only?

      The only issue with this type of practice, is finding enough patients, who have the means to afford this kind of health care out of pocket.

      Reply

  2. CMMarozasDO

    My first 2 years of practice were employed in a large corporation and the next 22 years (and still counting) have been in private practice. I call the employed years my “mall doctor” years because everything was expected to be seen by a specialist. Family physicians were the “gatekeepers” for the HMOs. I returned to my rural home town and joined a busy practice where we provide a high level of care for the full spectrum of patients. We all have different practice styles and interests, and are very well-rounded. The work is hard at times but very rewarding as patients are thankful (and spoiled at times) to see the same doctor in the clinic, ER and hospital. We do the procedural things that we like and refer when needed. We support each other on call and we all prioritize our families over work. We earn every cent we make and we do take insurance and those without. We have all learned how to run a medical business full of employees with insurance benefits, retirement, etc.. Our biggest challenge is recruiting new physicians who don’t understand independent practice or who don’t have the desire to cover all these areas and are lured by $$$. For me, it has been worth it to use my education and knowledge and experience to truly help my patients. The quality of life in rural America is fantastic!

    Reply

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