Home Forums Discussions General Discussion Small Shop Doctors an Endangered Species?

This is the title of an op-ed piece by the President of the Missouri Academy of Family Physicians last spring. I am disappointed that my state organization has decided that the organization should not put its support behind solo practice docs. It sees us as a dying breed.

Unfortunately DUES ARE NOT OPTIONAL TO THE STATE ORGANIZATION. I am not allowed to belong to AAFP unless I pay an organization that doesn't support me, several hundred dollars of hard earned money.

Small Shop Doctors,an Endangered Species?
Arthur G. Freeland, MD
MAFP President

Private practice is on the way out. Private practice has remained a “cottage industry” that is very responsive to patients, especially in small towns, but there is no way a small private practice can compete against subsidized primary care – whether the subsidy is governmental, such as Federally Qualified Health Centers, or ”deep pockets”, such as your local hospital.

I attended a primary care conference in 2007 where Dr. David Kibbe, HIT Advisor for AAFP, referred to private practice of medicine as "a failed business model".

The leadership of the national physicians organizations are standing around with a goofy grin on their faces for the Obama photo ops while their members are led off to slaughter.

Amazing Charts and the user board is one of the best resources there is out there for "Small Shop" docs.
I get a lot of support from AAFP, so between the national organization and AC, there's plenty of support out there.

This is just one of many ways the current reimbursement system is killing off primary care. In a hospital based or large HMO based practice, salaries of PCP's and pediatricians can be supplemented as they "bring in the patients" to the specialists. But even in those systems I have witnessed, there is great resentment that not everyone is "carrying their weight."

There was a series on PBS (now out on DVD) called "Roadshow Nation" about a group of college seniors interviewing successful executives in different fields on the paths they took to choose their careers. One of the students had applied to medical school because "she wanted to own a nice house and a nice car and be able to send her kids to fine colleges" but was unsure if that is what she really wanted to do with her life. It made me both sad and nauseated. If choosing medicine is really viewed as based on factors such as a luxurious lifestyle, then yes; we're doomed.

It is drastically different for general internists. The leadership of the ACP has been crowing about their role in getting the ACA approved, but ineffective on SGR rollback and mostly silent on liability reform, except to trumpet the trivial $25 million demonstration project on liability reform that Obama tossed them as a bone. Meanwhile, their online newsletter ACP Internist recently reported that Medicare's Actuary found the health care reform bill will "save Medicare", while the national press was reporting that health care costs will rise over 7% as a result of ACA. The last straw for many of us was the publication in the Annals of IM of a report by several White House insiders that primary care doctors would have to move into multi-specialty groups or hospital owned partnerships to "survive" the changes caused by the health care bill.

ACP members can't rely on the ACP for anything, except sympathy and bad advice.

I found a refreshingly frank perspective on the "new" phenomenon of physicians selling their practices to hospitals, er, integrated healthcare management organizations, for the purpose of "surviving" the coming healthcare sunami. Interestingly, it was written by the CEO and president of a web-based EMR company trying to get hospital business. It suggests that perhaps the sky is not really falling...
www.athenahealth.com/blog/2010/09/29/sowing-the-seeds…/

One of the speakers at the Academy of Pediatrics suggested that small private practice may not be a viable model as you have to jump through more hoops and adminstratively it would be easier to do this as a larger group.

Overall the AAP is very supportive of small providers however.

I personally beleive that solo family physicains will survive any health care tsunami as long as they beleive in themselves that they can do a better job than any large hospital group or oranizations.
They have to continue to be compassinate, keep a good front office staff, keep your overhead low and keep the lawyers away.
Infact most of the pateints who tranfer from larger group practices, do so because I am a solo physicain and my established patients want to be assured that i will not sell my practice or join a larger group.
Grenville

Agree with Grenville.

Thanks everyone for an interesting discussion. AC tends to attract small shop docs. The support here is awesome.