I can risk carpal tunnel syndrome arguing the significance of the Mars rover for the healthcare technology, or posit how the ACA is some sort of Malaysian conspiracy and find enough data and statistics to back me up – a feat made easier by the advent of tools like Google, a tool akin to high-end blush and mascara to help a writer’s argument stand out.
Whether you’re a philosophy major, high school debater, rowdy bar patron, or homeless theology enthusiast, framing arguments as questions about the future amounts to safer predictions, where there are fewer consequences if you don’t hit the mark, and you can play devil’s advocate more times than he can count on both his ‘idle’ hands.
With this in mind, the fact that journalists, talking heads, and experts in the healthcare field are asking whether the solo practice is going extinct is more reminiscent of smoke signals than bomb sirens.
Merritt Hawkins President Mark Smith testified about the ‘anachronistic’ progression of small, independent physician practices before the House of Representatives earlier this summer, claiming physicians today are more likely to be employed by medical groups and hospitals.
Anachronism is a bit of a powerful term, however, especially for a man who runs one of the largest physician-recruitment firms in the country. And agreed, the numbers are frightening – Merrit Hawkins, for instance, reports 65% of their physician-search assignments were placed in hospitals from April 2011 to March 2012, up from 11% in 2004.
What Smith isn’t taking into account, however, is the way solo and other small practices are evolving. It’s not so much an account of the death of the solo practice, much like the field of journalism isn’t dying because of an industry overhaul. The solo practice is simply evolving.
First off, solo practices are a long way from disappearing – 55% of U.S. medical practices are single-physician centers. And it’s hard to believe that these many physicians are going to give up on being their own bosses without a fight.
“Physicians are adapting to the changing practice of medicine by becoming patient-centered medical homes and participating in shared savings programs,” said Joseph Yasso, Jr., DO, a member of the American Osteopathic Association’s board of trustees.
And yes, these kinds of solo practices are associating themselves with ACOs and altering their character. Solo and small practice physicians are leading many of these, and then pushing organizations to participate in shared savings programs. This not only ensures survival, but it also means solo practices are helping to reform payment.
Also, as an indirect response to Merritt Hawkins’ declaration, the Physicians Foundation released a report regarding the future of medical practice in July, acknowledging the difficulties solo practices face.
The report, written by Jeff Goldsmith, PhD., says new practice models are evolving from the solo ‘micropractice’ to the patient-centered medical home to direct-pay service. These are new business models that also reinvent the way healthcare is delivered.
Cutting-edge technology helps the small practice’s case – revenue cycle management systems automate claims management and payment, while EHRs can improve communication between physicians. As a matter of fact, EHR adoption rates have jumped from 30.8% to 36.9% for solo practices, another indication that they’re not going anywhere.
Is the solo practice going extinct? It’s unlikely, and arguing impulsively about it isn’t really helping anyone, seeing as stifling the entrepreneurial spirit of solo practice physicians does little for the community.
Not to mention, touching upon some very real fears today is sometimes ridiculed tomorrow. I suppose a number of international policy geeks groan when they remember the Japan scare after the Plaza Accord, and technologists block the ’90s cell phone brain tumor scare from their memories.
You can add a question mark and get away with murder.
Solo practices helped innovate the way we treat patients for decades, and we shouldn’t expect them to go down so easily. If you’re into gloom-and-doom predictions, switch over to coverage of the economy for a talking-head rollercoaster. Leave the solo practices alone.
Do you know what you need when setting up a new medical practice?
