A survey of around 100 specialist physicians gives some insight into their perceptions of the current and future structure of their business. (ProCare Survey) We continue to report on these surveys of doctors because they are the critical component of the delivery system, controlling most treatment decisions, and their perceptions of the health system and their role in it are important factors in the individual care received by patients and the effectiveness of various efforts to “reform” the health system. Specialists tend to earn more than primary care doctors and are responsible for more total health spending. In the past, specialists largely functioned as individual or small practices, or in large multi-specialty groups, but as with primary care, many have been acquired and are employed by larger health systems. The survey reveals that while 73% of respondents want to remain independent, 44% say they are likely to sell their practice in the future. The reasons are pretty understandable. These specialists feel intense reimbursement pressure at the same time that costs are going up, largely due to regulatory requirements. They understand that “value-based” reimbursement is likely to continue to spread and they are not resistant to the concept, but do see it as adding more complexity to their businesses.
In fact, 47% identified the combination of revenue declines and cost increases as the most significant challenge for an independent practice, while 19% said it was maintaining referral streams in light of changes in the structure of the provider market. 70% say that these challenges have been exacerbated by the federal reform law. If they are to remain independent, 70% of these doctors said it was the specialized nature of their practice within their local health care market that would allow them to do so. Since most want to remain independent, 94% say the market should find new practice models that allow them to do so. 49% expressed an interest in the independent practice association model, while 28% said that a practice management/shared equity model was attractive. And 23% would consider mergers or acquisitions to build scale that might allow independence. Interestingly, the respondents believe that over the next few years there actually will be a migration of physicians who are employed by large health systems back to independent practice. This admittedly small survey does seem to accurately reflect a conundrum facing many physicians–how to balance a desire to remain independent and to control their practices with the increased complexity and cost of practicing medicine in today’s regulatory and reimbursement environment.