Solo practice physicians: 'I'm not dead!'

The impending demise of solo physician practice has been predicted for several years now. In early July, recruitment firm Merritt Hawkins put the proverbial nail in the coffin of solo physician practice by declaring it officially dead. But like the old man in 1975’s “Monty Python and the Holy Grail” protesting “I’m not dead!”, doctors aren’t ready to be hauled off for burial.

Call it denial, but many doctors while recognizing the dire state of solo physician practice aren’t ready to give up the ghost yet.

Just weeks after Merritt Hawkins’ death declaration was released, a report from the Physicians Foundation on the future of medical practice acknowledged the difficulties solo physician practices face, but, paraphrasing Mark Twain, insisted that “the reports of the demise of private medical practice are … exaggerated.”

[See also: Recruiting firm says solo physician practice is dead and Young doctors' outlook on the future of healthcare is gloomy.]

The Physicians Foundation report, written by Jeff Goldsmith, PhD, an associate professor of public health sciences at the University of Virginia, acknowledges the challenges solo physicians are facing, but offers a glimpse of the future, too, by suggesting that the tide toward employment will turn to new models in the coming years.

“There’s a rush towards employment because of the huge hassle and the payment issues,” said Lou Goodman, PhD, president of the Physicians Foundation, “but after a while, both the doctors and the hospitals, per se, may say, ‘Hey, wait a minute. This might not be the model for everyone.’ And we may start going back to, maybe not small practices, but physician-directed groups.”

Solutions to counteract the dwindling of solo physician practices also came up during a House Small Business Committee hearing on July 19. “The Hearing on Health Care Realignment and Regulation: The Demise of Small and Solo Medical Practices?” included testimony from four physicians and Merritt Hawkins’ president, Mark Smith.

They all noted the reasons for the decline of solo practice: flat or declining reimbursement; more regulations and administrative tasks; the cost of malpractice insurance; the burden of implementing information technology systems; the debt of medical school tuition; the upheaval brought about by healthcare reform; and the instability of the Medicare physician payment system.

But despite the glum statistics – Smith said that Merritt Hawkins projected that within two years, 75 percent of all newly hired physicians will be hospital employees – the doctors giving testimony were offering suggestions for saving solo practice.