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4 Strategies for Fed-Up Physicians

 |  By jcantlupe@healthleadersmedia.com  
   August 02, 2012

When the Atlanta-based healthcare staffing recruiter Jackson Healthcare recently took an online survey of physicians, it was pretty surprised and dismayed that 34% of physicians reported plans to leave the practice of medicine over the next decade.

 "What one doctor told me really struck me," Sheri Sorrell, market research manager for Jackson Healthcare, told HealthLeaders Media. The unnamed physician said he was in a grocery store with his wife and had an epiphany after they discussed "how my office worked, what I charged, and what my accounts receivable meant, and it was really nothing. Really," he wrote to Jackson Healthcare. "The insurance companies and the government decide how much I got for my services."

"Why was more of my life in a career that is becoming more and more restricted, more controlled by managers, clerks and accountants, more demanding, less fulfilling, less respected, and less financially rewarding daily?" the physician asked.

After two months, the doctor quit, according to Sorrell.

It sounded like the doctor was cataloging the symptoms of a disease state.  He represented the ailing state of physicians. Jackson Healthcare tallied the complaints: a "complex business environment, hassles with insurance companies, billing, collections, administrative work, hospital pressures and quality of life issues." Many physicians want to work fewer hours, spend more time with family, more time on vacation, provide less call coverage and gain a more manageable workload.

Among the public, "the perception is these guys are all filthy rich, but it's not true anymore, especially for those primary care docs," Sorrell says. "Some are just trying to keep their practices open."

But physicians are in the business of fixing ills, aren't they? Around the same time Jackson conducted its survey, The Physicians Foundation—a nonprofit organization that seeks to advance the work of practicing physicians and help facilitate the delivery of healthcare to patients—issued two reports that echoed what doctors view as their dismal state. But there was a twist: the reports said that physicians can take steps to control their own destiny and stay in business.

Stephen Isaacs, JD, an attorney and president of the Center for Health and Social Policy, and Paul S. Jellinek, PhD, former vice president of the Robert Wood Johnson Foundation, stated in their report that, "while it is indeed possible to survive and even thrive in private practice in the current environment, business as usual is not an option. Serious steps must be taken to the new realities and implementing these steps may well take some physicians outside of their comfort zones."

Jeff Goldsmith, PhD, associate professor of public health sciences at the University of Virginia, author of the other report, agreed. "Medical practice innovation holds the key to private practice being a viable alternative to salaried employment for the next generation of physicians," writes Goldsmith. "It holds the promise for both diversifying physicians' service offerings and for improving physician productivity."

In the reports, the authors offer suggestions for physicians that they should consider now, to get a handle on their practices—before they decide to get out of the business of caring for people. They cite physicians who "bucked the trend" of leaving and have maintained a sustainable practice. Among their immediate suggestions:

1. Fix your practice.  It's like cleaning house, taking note of what can be quickly improved, for greater efficiency. You may decide you like what you have after you make tweaks—some large and small—involving paperwork and employment of staff. It includes contracting out billing and collections; collecting co-payments and deductibles at the time of service; reducing or cross-training administrative staff, and employing mid-level providers.

2. Try a new practice model. Consider launching an extremely no-frills "micropractice " or concierge practice. The micropractice model is basically a solo practitioner who has no staff, with low overhead, who sees fewer patients each day and spends more time with them when they visit.

It's curtailing the stress and spending more time on care. Isaacs and Jellinek noted a 57-year-old Chicago physician who talked of his "ideal medical practice," in which he sees just 15 patients a day and spends an average of 27 minutes with them. 

A 43-year-old North Carolina physician moved into solo practice because of the "relentless pressure" from his previous job at a community health center. He has a load of only 650 patients and schedules 45 minutes for follow-up appointments with each patient.

As for concierge service, a patient pays an annual fee or retainer, for enhanced care. This arrangement offers flexibility for a physician. Some physicians also are embarking on "hybrid" practices that combines concierge, suited to patients who want specialized services and are willing to pay, along with their regular practices, Wayne Lipton, founder of Concierge Choice Physicians told me.

3. Improve your practice's digital technology now. Those that enable real-time claims management and payment, automate dictation and coding, and improve physicians' communication with each other and with patients "could lower overhead costs and enable more efficient practice," wrote Goldsmith. Medical practice innovation holds the key to private practice being a viable alternative to salaried employment for the next generation of physicians, he said.

4. Consider joining independent practice associations or merge with other independent practices that can provide "greater leverage" with hospitals and payers, as well as vendors. Although this move involves a loss of autonomy and control, it has a definite upside. Physicians' willingness to join organizations to manage population health risks will be essential to regaining control over their professional lives. "The alternative is to continue to have their clinical decisions micromanaged by health plans and Medicare," Isaacs and Jellinek state.

Obviously, these aren't panaceas, but the idea is to provoke some thoughts among physicians who will need to be flexible in a turbulent time.

"Both papers are saying that, with the amount of uncertainty created by all the paperwork requirements, the uncertainty over SGR (sustainable growth rate formula) payments, no one knows with clarity what the ultimate impact may be on healthcare reform," says Lou Goodman, PhD, president of The Physicians Foundation, and CEO of the Texas Medical Association.

In 2009, Isaacs and Jellinek wrote a report entitled, "The Independent Physician: Going, Going…" As they note in their recent report, the previous study discusses "the strong current of pessimism regarding the future of private practice."

"Such information as we were able to piece together about what has been happening since we wrote that paper, especially in many local health care markets, seemed to directly confirm that pessimistic outlook," the author wrote in the recent report.

"Yet as we started to learn more about some of those private practices that have somehow managed to buck the trend, and as we talked to the physicians who are running those practices, we began to wonder whether maybe, just maybe, this isn't the end of the private practice after all."

Of course, that remains to be seen.  And yet another report by healthcare researchers may tell that story, ostensibly "written" by doctors themselves.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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