While most physicians work in employed settings, there is a growing shift toward independent practice as concerns about physician autonomy and satisfaction persist.
Harry Haus, MD, medical director of Dr. Haus & Associates in Erie, Pa., has made the full circle from private practice to employment and back to private practice through his career in family and addiction medicine.
He recently told Becker's that things were drastically different when he first began his career. He was able to moonlight to earn enough money to start his own practice and faced much less start-up costs than your average medical student today.
"I got an MBA in accounting and finance, just in case I didn't get into med school …. But things were much easier all along back then. In Pennsylvania, you only needed one year of medical residency to get your license," he said. "Now, residencies don't want you to moonlight. I came out of residency and I made so much money moonlighting, I paid off my medical school debt and had $30,000 in the bank to open up my new practice four weeks after I graduated."
In 2000, Dr. Haus said that multiple factors pushed him out of private practice: multiple insurance providers went out of business and his practice insurance was "more than double," leading him to work in several different roles, including as the medical director of a hospital and for the U.S. Postal Service. In his various phases of employment, Dr. Haus witnessed the erosion of patient-centered care through increasingly restrictive referral policies, practice hours and other aspects of practice management.
"Putting patients first, treating patients as you like to have your own family members treated … that just doesn't happen. And then there's worse than that," he said. "You can't even do what's best for your patients. I'm old enough to remember when you called up the doctor, somebody actually answered the phone. You'd tell them you're sick, and he said 'come on up, I'll get to you. We're going to make sure you get better today.'"
This prompted his gradual shift back to private practice in 2007. He was working for the Department of Veterans Affairs at the time and was getting certified to treat opioid addiction patients with suboxone. He took over a practice from another physician and began opening up on weekends to accommodate the high demand for suboxone treatment in the area. He quickly hit 100 patients and was able to hire more physicians and begin expanding his practice.
The practice quickly began expanding into an interconnected ecosystem of family, addiction and occupational medicine. By establishing the practice as a place to obtain a physical for commercial driver licenses, for example, Dr. Haus encountered more people who needed treatment for substance abuse disorder, and focused on integrating these patients into the practice in a multifaceted way.
"We did more than just give them some suboxone and say, go home. We answered the phone 24 hours a day," he said. "Doing those little things — having Saturday and Sunday hours, answering the phone, helping people when they have a little tooth infection. Sometimes when people relapse it is because of pain, so if they get poison ivy, an ear infection, or bronchitis, … we see them and treat that condition so that they get better."
He emphasizes a few key elements of his practice setup that have allowed him to remain independent. First, he says that physicians should be strategic in their selection of commercial insurances.
"Most medical assistance insurances pay you so poorly that you can't succeed if you're in private practice with a bunch of medical assistance," he said. "You have to select commercial insurances that pay you." He added that he encountered numerous issues with payers when he first began his practice but through trial and error, was eventually able to secure a commercial payer mix that paid the practice sufficiently.
Diversifying your sources of income is another essential element in independent practice survival, he said, and marketing those services properly.
In the past, he marketed his practice by "going out to the trucking companies and [telling them], we do [commercial driver's license] physicals, and we can do them on Saturdays and Sundays, so your drivers won't miss work," he said.
He has also found success in simply marketing his practice throughout the local network of other medical professionals and community stakeholders, including psychologists, judges and emergency room physicians.
While the referral process is now one with significant red tape, building this network can demonstrate a level of care to patients that Dr. Haus said pays off tenfold, as patients begin to feel more ownership of their health.
"When you help them, when they see that you're trying to help them, they want to try to help you," he said. "Recognizing the people doing a good job really helps them succeed."