From New Jersey Monthly

Happier or Not? Independent Doctors Join Larger Groups

Wayne J. Guglielmo


November 03, 2017

In This Article

Doctors Discuss Their Experiences

Four physicians who have made the jump include ob/gyn Shayna S. Jones, 40, and otolaryngologist Karen A. Wirtshafter, 55, who left independent practice to join large, physician-run, single-specialty groups. Bruce Aronwald, 54, an osteopathic family physician, and cardiologist Gerald Sotsky, 55, joined hospital-affiliated medical groups. Here, they reflect on their experiences:

Dr Shayna S. Jones, Lifeline Medical Associates

Since 2007, when she completed her residency in obstetrics and gynecology at Saint Barnabas Medical Center in Livingston, Jones has been riding a roller coaster.

Her first job ended abruptly, after the small practice she joined realized it couldn't afford to pay her salary, malpractice insurance, and health benefits. In mid-2008, Jones was approached by a solo practitioner, an ob/gyn who was starting a job with Planned Parenthood and wanted someone to take over the office in Livingston she shared with a second doctor. Jones signed on. The next year, she and her new office-mate moved to a bigger office. Then came what Jones calls her "crazy period." By then married with a young son, she was running her practice, preparing for her oral boards in obstetrics and gynecology, and delivering babies in the middle of the night.

About 30% of her patients were on Medicaid, the government healthcare program for low-income individuals and families, which made referrals to other practitioners difficult. In 2010, Jones became pregnant with twins, one of whom she would lose late in her pregnancy. Emotionally and physically spent, she took time off to recover.

In May 2011, she returned to the Livingston practice and also took over the practice of a doctor retiring in Maplewood. The new practice accepted only private medical insurance, which made life a little easier. Still, she was shuttling between two offices and juggling burdensome administrative tasks. That August, a former residency colleague informed Jones that her practice—the Women's Care Source in Morristown—wanted to add a sixth physician. The practice was part of Lifeline Medical Associates, a single-specialty group founded in 1997 by Dr John Feltz to, among other things, gain leverage in negotiations with managed-care companies. Lifeline—which today has 100 physician members—had a system-wide EHR and a behind-the-scenes financial team. To Jones, it indeed seemed a lifeline. "A huge lightbulb went off in my head," she says. "Aha, so this is how people survive—by having someone else do the administrative and other work for them!"

Feltz, president of Lifeline, says group practices have become indispensable. "Medicine has traditionally been a cottage industry in which doctors were autonomous and independent and did the best they could," he says. "Today, though, we can only make healthcare better if we put a bigger infrastructure in place."

In December 2011, Jones joined Women's Care Source and, thereby, Lifeline. She closed her Livingston office and now works only out of Springfield, where the Maplewood office relocated in September. In December, she anticipates becoming a full Lifeline partner, meaning she will share in its profits.

Shayna Jones is finally happy. Her patients tell her she seems more relaxed and responds to them in a more timely and effective manner. "With the support I get," Jones says, "I'm able to pick up on details I wasn't able to previously."

Dr Karen A. Wirtshafter, ENT & Allergy Associates

The daughter of a primary care doctor who practiced in Burlington County, Wirtshafter joined a two-person practice with offices in Denville and Dover after completing her residency in otolaryngology at Montefiore Medical Center/Albert Einstein College of Medicine in New York in 1991. She made partner 5 years later and successfully weathered changes in group personnel for almost two decades.

By 2006, however, cracks began to show. Managed care was driving down group revenues. The woman hired to manage the practice was "lovely," Wirtshafter says, "but had no specific training in administration, billing, or the tools one needs to navigate the very complex world of healthcare today." One of those tools was an EHR system, which the practice could ill afford, nor did it have the capital to move into a larger office with more exam rooms, which it desperately needed.

"The problem with being in a small practice," says Wirtshafter, "is that any big expenditure comes out of the bottom line, which is to say, your pocket." To add to the stress, the 2008 presidential election had raised the specter of healthcare reform. "A lot of rumors were flying around in terms of what we [doctors in private practice] would need to do," she says.

Then her husband, a general surgeon, told her about ENT & Allergy Associates. The concept was straightforward: Formed in 1998 by the merger of 12 physicians from three groups and eight locations, the group gathers otolaryngologists and allergists "under one umbrella, one governance program, and one EHR," says CEO Robert Glazer. Currently, the umbrella covers more than 160 doctors in more than 40 separate offices in northern and central New Jersey and New York State.

The group is structured like a law firm. New doctors, whether recruited out of residency or from private practice, come in as associates and after 6 years become eligible for partnership and a share of the group's net revenue. "After 3 years, our associates are making more money than most partners in other practices," Glazer says. "And when they become partners, they do even better."

In 2008, Wirtshafter and her partners (one retired before the merger) joined ENT & Allergy Associates. Almost immediately, they were moved out of their Denville location and into a larger, brand-new office in nearby Parsippany. Like all offices in the group, it's plugged into the system-wide EHR.

Besides the EHR, Wirtshafter enjoys having a tech expert on call to solve computer issues, a central HR department to handle staff problems, a central office to do the billing, and consultants at Mount Sinai to turn to for unusually complex cases. She's grateful not to be practicing in a small group. "I think it would be very difficult," she says.


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