Physicians who deliver patient care in private practice settings may not have access to the deep financial resources of large integrated health systems. But according to a qualitative study conducted to assess the factors that characterize high-performing, physician-owned practices, they have some significant advantages when compared with larger health systems—ones that doctors, patients, policymakers and other key stakeholders should know about and incorporate into health care-related decisions.

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Researchers drew from a national sample of the 3,526 physician-owned practices of no more than 15 physicians that were eligible for bonuses in the federal Merit-based Incentive Payment System (MIPS) program. They recruited 25 respondent practices, interviewing 25 doctors from these practices. The report, “Supporting and Promoting High-Performing Physician-Owned Private Practices: Voices from the Front Lines” (PDF), was co-published by the AMA and Oakland, California-based Mathematica, a consulting firm.

Although there are fewer physician private practices around now than a decade ago, the authors noted that 49.1% of doctors either own or are employed by a physician-owned practice, so the number of people who rely on these practices for care is still high. The physician leaders interviewed identified three benefits of this practice model for physicians and their patients: accessibility, flexibility, and autonomy.

The practice model enabled these physicians to be very accessible to their patients, encouraged continuity of care, and supported close physician-patient relationships.

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Interviewees also said physicians in these practices valued flexibility when determining the appropriate course of treatment with patients they knew well. Flexible work schedules could be adjusted to meet patient needs and their own need for work-life balance.

The primary advantage cited by these physician practice leaders is autonomy. They placed a high value on being able to make decisions related to hiring, firing, purchasing equipment, setting business hours, and other operational matters more quickly than their counterparts in large health systems.

Relationships and professional identity

Respondents also praised their unique practice circumstances and the emotional rewards.

“I love my job. I don’t have a job; I have a hobby. I don’t have a practice; I have a family. I really mean that. ... And my other partners that went to corporate America, I know for a fact that they can’t say the same. ... I couldn’t do it. I couldn’t drink the Kool-Aid. It’s magical, because I give quality care 24/7,” said a physician from a small general surgery practice in the Northeast.

“There’s a sense of pride ... that I’m employing seven individuals and a sense of ownership and [am] actively being involved in the community,” noted a physician with a solo primary care practice in the South. “If you want to do free sports physicals, you just sort of do it. ... And so, there’s definitely a pride, and that’s a key factor for me.”

Kathleen Blake, MD, MPH, is one of report’s authors and a senior adviser to the AMA on practice sustainability. She said interviewees also noted some management advantages to private practice, particularly when the practice is evaluated through the lens of patient care—not institutional profitability.

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Physician-owned private practices can focus more directly on overcoming obstacles that interfere with patient care, she said. And doctors can more effectively work with colleagues who share the same values and attitudes.

“If you are in private practice, you get to work with partners that you choose to work with. When you hire, you can prioritize finding people who share the practice’s values, work ethic and commitment to patients and the community. You decide together what hospitals and health plans you will work with,” said Dr. Blake, who led a private cardiovascular practice prior to joining the AMA.

It takes astute clinical judgement as well as a commitment to collaboration and solving challenging problems to succeed in independent settings that are often fluid, and the AMA offers the resources and support physicians need to both start and sustain success in private practice.

Find out more about the AMA Private Practice Physicians Section, which seeks to preserve the freedom, independence and integrity of private practice.

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