Nearly 80% of physicians now work in an employed setting. Here are five ways the remaining 20% keep their practices independent:
1. Caution around contracts. Vladimir Sinkov, MD and CEO of Las Vegas-based Sinkov Spine, who opened his own practice in June 2020 after leaving a large group practice, told Becker's that caution should be taken around signing new contracts. While sometimes necessary, physicians should be aware of what they're signing away and what the real value of their exchange is.
Contracts contain obligations, and by definition we lose independence because we give it up," he said. "Nowadays, the rewards of those contracts, in terms of patient volume and money, don't match the amount of rules, regulations and restrictions placed on us as physicians."
2. Be attuned to state and federal laws, especially those regarding Medicare. Physicians rarely have the capacity to lobby for specific policy changes and often lack the influence of large hospital systems. But by becoming as familiar as possible with various state and federal laws, they can make more informed decisions about what kind of practice will allow them the most independence.
For Sinkov, the most restricting regulations were tied to accepting Medicare, which led him to stop accepting Medicare patients in his new practice,
3. Decline payer agreements that include lower reimbursements. Reimbursement rates have steadily been declining in recent years, making it difficult for physicians and small practices to remain independent. This is another area where Sinkov finds that the negatives don't always outweigh the positives for accepting Medicare patients and, when possible, canceling contracts that lower reimbursement rates altogether.
"If you’re reimbursed less for your work, it becomes harder to negotiate for resources like equipment and you lose financial independence," Dr. Sinkov said.
4. Branch into untapped markets. Opening into communities with more underserved medical needs can secure patients that may become loyal and remain with independent physicians even if a larger system extends into the market later on. William Bradley, MD, is a spine physician who runs an independent practice in Meridian, Idaho. He told Becker's that after the system he previously worked for closed, he looked to the smaller, more underserved Meridian to open up his independent practice.
"There wasn't a ready ability for the existing healthcare systems to absorb these people, and they're still scrambling and looking for primary and specialist care," he said. "It became quite obvious that the best way out of this was to roll up our sleeves and take it upon ourselves to provide care for not only our existing patients, but others that needed help."
5. Reel back on competition between physicians. For Sinkov, competition among physicians creates divisions that prevent them from uniting and collaborating to lobby and advocate for themselves.
"We're so used to competing in college, medical school and residency that it becomes a habit," he said. "This weakens us, as we compete for patients, market share and resources while entities like hospitals, insurance companies and the government divide and conquer us."