From New Jersey Monthly

Happier or Not? Independent Doctors Join Larger Groups

Wayne J. Guglielmo


November 03, 2017

In This Article

Dr Gerald Sotsky, Valley Medical Group

Before joining Valley Medical Group 3 years ago, Sotsky and his four partners offered a range of services to their cardiac patients, from general cardiology to complex interventional procedures. Still, they had to refer patients with certain medical problems to specialists in other groups—a cardiac surgeon for bypasses or a cardiac electrophysiologist for electrical abnormalities of the heart, for example. "It's probably not the best way to take care of patients," says Sotsky.

After 23 years in private practice, Sotsky and his partners decided it was time to merge with a larger system in which doctors, he says, "pool resources and intellectual information and create a whole that's bigger than the sum of its parts."

Valley seemed like the perfect fit. As attending physicians, Sotsky and his partners already admitted most of their cardiac patients to the Valley Hospital in Ridgewood and had been active in many of the hospital's quality initiatives.

"If you're a physician group," says Marc Goldstein, president of the Valley Medical Group, "you are going to look for a hospital that will provide good-quality care at the lowest possible cost and work hard to keep patients out of the hospital and out of the testing arena unless it's medically necessary." What Valley looks for, Goldstein adds, are established, specialized groups like Sotsky's to broaden its reach in the new medical economy.

Three years after joining Valley, Sotsky chairs its cardiac services and directs the hospital's coronary care unit. He appreciates the group's fully integrated EHR, its billing and administrative service, and its intellectual resources. "We're in the process of bringing on a congestive heart failure specialist—a sort of super-interventionalist who treats valvular and other heart disease," he says. "No one small group would have been able to do this."

Sotsky says membership in the larger group has come with no loss of autonomy. Hospital officials don't tell him how to practice, he says, and they take his input seriously. Besides, he adds, "with so many government and insurance regulations, is anyone truly autonomous at this point?"

Not all practice link-ups are successful; in fact, some mergers fall apart. "Right now, I have one situation where the doctor is triggering the unwind and another where the hospital is," says attorney John Fanburg. In the first case, he says, the hospital is not managing the practice the way the doctor, a female primary care physician, expected, whereas in the second case, the hospital thinks the doctors aren't pulling their weight economically. "In each instance," Fanburg says, "the hospital has been very cooperative. The attitude is, 'We're still in the same community—let's move on together.'"

Still, Fanburg expects consolidation to continue in New Jersey and elsewhere. He tells doctors, "If you're in a one- or two-person group, you can't manage, can't afford the infrastructure you need to survive economically in this environment. Now, what kind of larger group is best for you? Let's talk about that. What you don't want to do is to wait until you wake up one morning and think, 'Oh my God, what happened here?'"

Is independent private practice a dinosaur? "In the near future, I don't see the end of private practice," says Valley's Marc Goldstein. "Five to 10 years from now, though, I don't think it's a sustainable model. Kids coming out of residency and fellowship don't have the desire to work 14-16 hours a day and be entrepreneurs. They're looking for employment. So these late- and mid-career practices will wind down, and they won't be replaced."


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