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Should you join a system or stay independent?
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One of the tougher questions facing physicians right now is whether to stay independent. There is a great deal of uncertainty in the health care marketplace, and that uncertainty understandably breeds fear. That fear contributes to a bit of a “run on the bank” mentality, as physicians join systems.
For primary care physicians, whose incomes in some cases don’t reach the six figures, the pressure to join a system started years ago. Now specialists are increasingly worried. What should you do?
Market advantage
Obviously, individual facts and circumstances may vary, but I still believe that orthopedic surgeons and many other specialists are in a good position to remain independent. In fact, if done properly, I think you can convert the rapid consolidation into a market advantage.
I have little doubt that the wave of consolidation will continue in the short term, and possibly increase. Enthusiasm over ACOs, which I still think may be misplaced, the high cost of electronic health records (EHRs), and challenges recruiting are all making joining a system somewhat appealing.
But few patients seem to love giant health systems. Generally speaking, in health care and out, Americans are not fond of giant bureaucracies. When patients are able to choose between a visit to the hospital, and a visit to a physician clinic or ambulatory surgery center (ASC), the clinic/ASC option is consistently on top. Smaller organizations are often more appealing than larger ones. I suspect that physicians who are able to stay independent may find that they have some extremely loyal patients. It will be necessary to find capital for investment in things like EHRs and medical technology, but if you are part of a group, that should be relatively easy.
Health care pyramid
I think it will be difficult for solo practitioners to make a go of it, but groups of specialists may actually find themselves at the top of the health care pyramid. Groups of specialists will have negotiating clout with payers. In fact, large enough groups may be in a position to create their own health plan – a strategy that merits some consideration. If you are currently a solo practitioner or in a very small group, then you may wish to consider joining with other physicians – whether it be other orthopedic surgeons or other specialists. As discussed in earlier blogs, you can use a divisional merger as a means to join together with a minimal loss of autonomy.
I don’t know what the future holds, but I have a strong hunch it will feature patients who are frustrated with large organizations. And patient frustration will offer opportunities.
