Private Practice--Down but Far From Out

Shelly Reese

Disclosures

November 01, 2017

In This Article

To Succeed, You Need That 'Secret Sauce'

Not all doctors who return to self-employment return to their old ways. Whaley says many are adopting new practice models, including patient membership, concierge, traveling, and house-call practices, as well as direct primary care. What's more, they're slashing their expenses by renting space from other physicians, taking advantage of affordable voiceover Internet phone technology and free electronic health record (EHR) systems, and tackling a lot of administrative tasks themselves.

Others are banding together with like-minded peers. In addition to her consulting role, Whaley is the chief operating officer of Chapel Hill Doctors Healthcare Center in Chapel Hill, North Carolina, which she describes as a private-practice incubator. Founded in 2007, the center provides shared office space and administrative services with 13 independent practices whose services include integrative health, primary care, ophthalmology, gastroenterology, gynecology, and psychological counseling.

Some doctors are "looking to be out from under the thumb of the hospitals," Whaley says. "If they're willing to forego the fancy schmancy, put up with an EHR that doesn't have all the bells and whistles, and not have a sign with gold letters that are three feet high, they can do it.

"It's really a question of, what are your expectations?" Whaley says. "Are you looking to make the same salary and benefits you got with the hospital? That's not likely to happen." Independent practice "is not for the faint of heart."

In 2012, Cincinnati internist Lisa Larkin, MD, then in private practice, was faced with the prospect of purchasing an expensive EHR or joining a health system where she would be given the opportunity to launch a comprehensive women's health center. She chose the latter, opting to leave private practice to join the ranks of the employed.

But the arrangement didn't take. Dr Larkin felt "handcuffed by a non-limber, overly regulated hospital system," and her long-time patients complained that they couldn't get in to see her. Last September, she reopened her private practice using a combination direct primary care and concierge model.

"Primary care is a very personal relationship between a physician and a patient, and I was absolutely miserable when I went to employment," Dr Larkin says. "It was much more a numbers game. I felt like a factory worker. And at the end of the day, I was not happy with the quality of care I was providing."

Dr Larkin, who purchased and expanded the building in which she works and leases her EHR from a health system where she serves as a medical director, admits that taking on enormous debt was daunting, but her previous experience of running a practice, as well as her enthusiasm about offering new services such as telemedicine and nutrition counseling, gave her the nerve to make the move. Today she cares for 920 patients, a number she plans to cap at 1200, roughly 100 of whom will be concierge patients.

While most doctors may gravitate to the employed model, Tommy Bohannon, vice president of sales operations at the physician recruiting firm Merritt Hawkins, says those who opt for independence—particularly in solo and small practices—need to differentiate themselves and find other ways to make money other than billing for CPT codes and office visits.

"Think about it from the consumer's perspective," Bohannon says. Doctors who want to return to private practice are asking patients to give up the conveniences and amenities afforded by a large system, such as weekend and evening hours, onsite labs and pharmacies, and elaborate patient portals. As a result, to entice patients to follow them, these doctors are going to have to make a compelling case for themselves, Bohannon insists. "They're going to have to have that secret sauce to make money."

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