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How to survive in independent practice

Finding strength in numbers and developing business savvy can help physicians retain their autonomy


Medical Economics Fighting Back SeriesDespite a healthcare environment that’s pushing physicians toward employment, many doctors still value their autonomy, and are exploring strategies—from banding together in physician independent associations or consortiums to enhancing their business strategies—to preserve their independence in the face of increasing burdens and financial difficulty.

Read: Why cost may give independent physicians an advantage over hospitals

Orthopedic surgeon Barbara Bergin, MD, is running out of options for keeping her private practice in Austin, Texas ahead of the economy. With her partners, she has expanded Texas Orthopedics Sports & Rehabilitation Associates from three to 25 physicians, making it more cost-effective to handle escalating medical records requirements. Meanwhile, the practice invested heavily in technology and staff to make paperwork more efficient.

Nonetheless, after 27 years in private practice, Bergin often faces a workday that stretches beyond 12 hours, starting with surgery at 7 a.m. and extending into the evening, as she fills out forms for insurance company reimbursement. Meanwhile, she says her income has gone down, and she has less time to see patients.

“I do hours of paperwork and things that don’t really contribute to the care of my patients,” says Bergin, 60. “That’s very frustrating.”

Bergin is not alone in finding that running a private practice has become an obstacle course, where regulatory burdens make it ever-harder to focus on treating patients and stay afloat financially.

“It is a diminishing margin business,” says R. Brian White, who advises medical practices at Competitive Solutions, a Nashville-Tennessee-based consultancy he founded in 1992. “I think it’s important for physician practices to realize that.”

Against this backdrop, more physicians are leaving independent practices and joining hospital systems as employees. If you don’t want to go that route, yet still maintain your autonomy, it is critical to look at your practice like a business owner. Many physicians are finding strength in numbers and joining organizations such as independent practice organizations (IPAs).

The IPA Association of America, a trade group, says it represents more than 300,000 physicians associated with IPAs. Physicians who join IPAs maintain their independence, but become part of a separate organization that contracts as a group to provide services and can negotiate better reimbursement rates with insurers.

“Outside of the IPA, the physicians are free to compete with the other members of the IPA for other business that the IPA is not contracting for them,” explains John Kancilia, shareholder with the law firm, GrayRobinson, P.A., which has offices throughout  Florida.

IPAs are just one possible way to become more productive, free yourself from time-draining minutiae and trim unnecessary costs to preserve your independence—without sacrificing your relationships with patients. “I wish more doctors understood that they can be successful without the big entity behind them,” White says. “They do have to be smarter about how they go about their business—and run it like a business.”

Independent Physician Associations

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