Fewer physicians than ever maintain a private practice, but among those that remain are some of the best performers—managing their resources well and serving up great care for their patients. What’s the secret of their success?
Kathleen Blake, MD, MPH, a senior adviser to the AMA on practice sustainability, discussed the results of an AMA-sponsored study that probes the ups and downs among high-performing, physician-owned private practices during an episode of “AMA Moving Medicine.”
Although there are fewer physician private practices around now than a decade ago, 49.1% of doctors either own or are employed by a physician-owned practice. “The number of people who rely on these practices for care is still high. We wanted to learn from the practices that had ... been recognized for high performance. What was the secret sauce?” said Dr. Blake, who at the time of her appearance was the AMA’s vice president of health care quality before stepping into an advisory role earlier this year.
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.
Independence brings positive attitudes
The study identified several positive attributes of physician-owned private practices, Dr. Blake said. “They are fiercely proud and identify strongly with their practices. And so by identifying in that way, it's also with their patients, it's with their community; there is a connectedness that—for them—is a very strong motivation.”
“These were physicians who liked having that responsibility because they could make the decisions based on a complex set of circumstances in their environment. They also liked the fact that they didn't have to go through multiple layers of administration to reach a decision, and especially that they could hire the people they worked with.
“And that was especially important with respect to bringing in new physicians,” Dr. Blake said. “But it also applied to the office managers, nurses, and others who they would be working with to take care of patients.”
Patients also responded.
“Just as the doctors knew they were accountable, their patients knew that the doctor was accountable. And so there was, I think, a strong bond that is perhaps harder to establish when you are at a very large health system level.”
“AMA Moving Medicine” highlights innovation and the emerging issues that impact physicians and public health today. You can catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version, which also features educational presentations and in-depth discussions.
Administrative burdens run high
Physicians in private practice need to be prepared for some challenges—particularly in their administrative roles.
“There is no question that the administrative burden of running a practice is quite separate from the clinical burden and the clinical knowledge and excitement and reward that comes with taking care of patients,” Dr. Blake said.
“These were physicians who had to be both caregivers, doctors, as well as businesspeople. So, the changing of rules, regulations, payment schedules—sometimes on a yearly basis—was very difficult.”
The study also identified a recruitment challenge. The medical education process allows for little access to private practices, Dr. Blake said.
“Young physicians now, as they go through medical school and then through their graduate medical education, may not spend time with private practices. They may spend most of their time at an academic medical center,” she said, and unless recruited into a private practice, don’t have the opportunity to experience the advantages. Also, many private practices just can’t afford or offer the financial and other incentives to be successful when recruiting.
It takes astute clinical judgement, effective collaboration with colleagues, and a capacity for innovative problem-solving to succeed in an independent setting that is 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.