From New Jersey Monthly

Happier or Not? Independent Doctors Join Larger Groups

Wayne J. Guglielmo


November 03, 2017

In This Article

Do Doctors Even Have a Choice?

But even with access to world-class medical resources and multiple insurance carriers, New Jersey doctors are finding it difficult to maintain independence since the rollout of Obamacare. Like doctors in other parts of the country, physicians here are asking themselves: How can I best participate in the new medical economy, with its value- and data-driven payment schemes? Can I afford the new technologies that make participation possible? Can I afford the administrative costs of running a small practice? And most crucially, can I deliver the best patient care under the new system?

Newly minted doctors don't have much choice. In a recent survey, the healthcare recruiting firm Merritt Hawkins found that more than 90% of new doctors "will be employed by hospitals, medical groups, community health centers, academic medical centers, or other facilities." Fewer than 10% of the job placements are in independent settings, such as partnerships or solo practices. A decade ago, 45% of new doctors went to work in small or solo practices.

As for veteran doctors, some, like Rombough, have bid adieu to independent practice. Others are trying to ride things out, hoping that recent changes in healthcare will fade in time like a bad head cold. Others, closer to retirement, are just hanging on until they can exit.

"I hear so many physicians these days say, 'I can't wait for [my children's] college tuition payments to be over so that I can retire early," says Debbie Puccio, president of the New Jersey Medical Group Association.

The trend, though, is clear. The New Jersey Hospital Association, the state affiliate of the American Hospital Association, reported a 16.5% increase from 2008 to 2012 in the number of doctors and dentists employed by hospitals in the Garden State. Nationally, the increase was 20%.

Typical of the trend is the hospital-affiliated Valley Medical Group. It has grown from 90 physicians in 2010 to 203 physicians as of September. The group is part of the Ridgewood-based Valley Health System.

Doctor-run medical groups, particularly multispecialty groups, are showing a similar surge. "This year, between residency, fellowship, and acquisition, we'll probably end up on-boarding about 140 doctors," says Jeffrey D. LeBenger, an otolaryngologist and chairman and CEO of SMG, which is on track to becoming a 500-doctor group. Another doctor-run multispecialty group, Advocare, which serves New Jersey and eastern Pennsylvania, has grown from 30 physicians in 1998 to more than 600 primary care doctors, specialists, and nurse practitioners.

Doctors who have joined a larger group have generally seen the move as positive for themselves and their patients, although no transition is seamless.

Precisely because they are peer-owned (and sometimes peer managed), doctor-run groups appear to be easiest for doctors to adjust to, despite the guidelines for patient care they often impose on members. "We're not policing them or telling them they have to do such and such," says SMG's Brenner. "We're offering them operational support." SMG shows its doctors how their patients are doing compared with those treated by other doctors. "When doctors see their patients are at the bottom of some list," says Brenner, "you wouldn't believe how quickly the dial moves in the right direction."


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