Reading the headlines and talking to experts in the field, you would think that private practices were becoming about as hard to find as video stores or 8-track players. But despite reports of their demise, the independent community doc is still alive and well, according to new data released last week.
The American Medical Association recently polled a random sample of about 3,500 post-residency physicians who work at least 20 hours a week. And while the number of doctors employed by hospitals has gradually increased over the years, the majority (53.2 percent) were still self-employed as of last year. AMA President Ardis Dee Hoven, M.D., is encouraged by the findings, and believes it's vital to preserve private practice while making sure solo doctors are connected with others in the field.
"I think it's very important because many patients don't necessarily want to be cared for in big systems. They really want to stay with their primary care physician, their internal medicine physician in their local community," she told me by phone last week. "Our job in the health care sector is to be sure that everybody is interconnected and that we make good use of the interoperability of electronic records, that we share information and knowledge, and that the care is seamless and coordinated."
About 60 percent of physicians worked in practices owned by their peers, the survey found. Meanwhile, 23.4 percent of those surveyed worked in practices at least partially owned by a hospital or health system, and another 5.6 percent worked directly for a hospital.
The number of physician-owned practices has gradually dwindled since the AMA started tracking the numbers back in 1983, from 75.8 percent at the time, to 53.2 percent in the most recent data. That number represents an 8 percentage-point drop from the previous survey five years ago, as stagnating reimbursement rates, the search by docs for a better work-life balance, and hospitals's desire to expand market share have driven up physician-employment by hospitals, according to the survey.
Some other findings:
- Younger physicians were less likely to own a practice. About 43.3 percent of doctors younger than 40 are practice owners, and about 60 percent of those 55 and older are their own bosses. Women, too, were less likely to own a practice, at 38.7 percent compared with 59.6 percent for men.
- The number of docs in solo practices has greatly decreased since the inception of the survey. In 1983, about 40.5 percent of physicians were on their own, which has dropped to 18.4 percent in the most recent findings.
- Multispecialty practices appear to be more attractive targets for hospital ownership, according to the survey, driven partly by "the need to have strong ties with primary care physicians." Some 43.6 percent of multispecialty practices said they were at least partially owned by a hospital, compwithared about 21 percent of single-specialty practices.
Hoven is unsure whether 2014 will see an increase in the clip of doctors looking to hospital-owned practices for employment. Regardless, she thinks providers need to be ready to provide care to a whole bunch of new patients, in whatever setting they might prefer to receive it.
"Things will be changing rapidly and what we want to see in this country is that the patients get the care they need at the right place, at the right time by the right provider," she says. "How ever we need to help make that happen, that is what we need to do. I think right now we don't know. We just have to wait and see how these new changes will impact us and stay tuned."