Many sources cite the fact that only 30 percent of doctors remain in private practice. And many doctors continue to close their doors. In the area I practice family medicine, two doctors recently retired and the patients are scrambling to find a new primary care doctor. Many doctors left their own businesses to become employees of larger groups or hospitals. Others changed careers or took a non-practicing job in medicine. And it is expected that few doctors will remain self-employed. In fact, of doctors polled on SERMO (the largest social network exclusive to physicians) only 53 percent believe that the private practice model will survive the next decade.
Why are doctors fleeing from private practice?
The overhead costs to own a medical practice have soared. In the meantime, reimbursements remain stagnate or even decrease. Many doctors simply cannot afford to stay in business. As doctors, we never received any formal training in business so we are at a disadvantage from the beginning. Most of us learn the business aspects of medicine in real time. Owning a business while practicing medicine is just unsustainable for many.
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The new mandates being tossed at us are unduly burdensome. It is very difficult for a small practice to keep up and comply with these mandates, meaningful use, PCMH, PQRS, and others. For example, in order to become a certified PCMH, I devoted one of my staff full-time to the task for several weeks. This was not an extra employee I had but one that I pulled from her usual job. This created a large burden on the remaining staff to fill the void. As a private practice, I do not possess an IT department nor can I draw from a pool of temporary employees. This was a huge time drain on everyone and many small practices simply cannot do this. And now, doctors who do not comply with these mandates face penalties in our reimbursements. This comes at a time when many small practices struggle to just stay afloat.
Doctors always battled to attain some degree with balance between work and their personal lives. As a business owner, more hours are required to run the financial aspects of the business. And as medicine innovates, it is hard enough keeping up with medicine these days. There are only so many hours in a day, in a week. There is just not enough time to maintain a practice of medicine and be a business owner these days. Many doctors sincerely just want to get their lives back.
Doctors in small practices remain isolated. It is illegal for doctors to form unions or collectively bargain. The sense of isolation can be overwhelming as we try to climb this mountain and feel all alone doing it. Many private practice doctors feel crushed by the system, yet feel there is no support or help in striving through to the summit. This sense of isolation is a large contributor to physician burn-out.
These are a few reasons doctors are being driven from being self-employed private practice owners. The pressures mount daily and they detract from our abilities to provide good medical care to our patients. They are a time drain and we spend much time on useless tasks for which we receive any financial or personal satisfaction.
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I still believe that I provide the best care to my patients when I am fully in charge of all the decisions in my practice, from the hours the office is open to the kind of exam gloves we purchase as well as the services we offer. Despite the mounting tsunami of pressures to forgo private practice, I and others will stand firm because we want the best for our patients. Perhaps the day will come when I leave private practice. But, I expect that would be the day I die. Do we want doctors herded into large groups and forced to follow those conventions? Or do we want doctors who are free to truly practice medicine in the way it is supposed to be?
Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter's University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University and other institutions. Dr. Girgis earned her medical degree from St. George's University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University where she was recognized as intern of the year. She is a blogger for Physician's Weekly and MedicalPractice Insider as well as a guest columnist for HIT Outcomes. She has had articles published in several other media outlets. She is on the medical advisory board of SERMO. Recently, she has authored the book, “Inside Our Broken Healthcare System” and "The War on Doctors". She has been interviewed in US News and on NBC Nightly News.
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