I recently came across a blog post written by Dr. Rob Lamberts, a private practice doctor, who after 18 years decided to leave his practice. Lamberts cites frustration with the current healthcare system as the reason for his move from private practice into concierge medicine.
Lambert’s move is part of a growing trend among private practice physicians who find it difficult to strike a balance between practicing good medicine and good business. Each year, an increasing percentage of the physician workforce is forgoing the autonomy of private practice in exchange for the stability of working for a hospital, concierge medicine, locum tenens, or even retirement. Accenture estimates that in 2013, less than one-third of physicians will be independently employed. In 2000, 57 percent of physicians were in private practice.
I recently spoke with Dr. Tom, a locum tenens hospitalist, who last December closed his private practice in Virginia. A decreasing referral base and increasing list of regulatory requirements made it hard to stay financially viable.
Tom’s story is not unique. Hospitals and health systems are realizing the benefits of using hospitalists to increase their market share. Unfortunately, that can devastate a private practice’s referral base. After all, hospitals and health systems are more likely to refer patients to their own hospitalists rather than private physicians. Such was the case with Tom, who saw his referral base “evaporate” in just two years.
“Even my private patients were going to the emergency room and were admitted to the hospitalist,” Tom said. “I would never hear about them until they were in the hospital or usually until they were discharged.”
If that wasn’t bad enough, Tom was expected to invest thousands of dollars to comply with new regulatory requirements. In particular, Tom said it would have cost $25,000 to update his computer system to comply with Medicare’s EHR meaningful use requirements. “Most [private practices] don’t have that lying around,” he said.
The Locum Tenens Solution
Since closing his practice, Tom has become a full-time locum tenens hospitalist, specializing in pulmonary and critical care. It’s a move he is happy with. Without the overhead costs that come with running a practice, Tom is now earning more money than he was as an independent provider. He also has no shortage of work. In fact, he said that he turns down many offers to work because he simply doesn’t have the time.
For the most part, Tom said he tries to take local assignments. Right now he is working within 35 miles of his home, which means he can commute each day. When he does travel, Tom says he often encounters fellow former private practice doctors who have either retired, gone to work for a hospital, or become full-time locum tenens.
Manoj Jain, an infectious-diseases doctor in Memphis, wrote a column for The Washington Post where he said, “The prognosis for a private practice looks grim.” He suspects it will only be a matter of time until there are only a few private practice physicians holding out based on principle and stubbornness.
Tom also expects fewer young doctors, fresh from training, to strike out on their own and start their own practice. He actually suggests young doctors consider a locum tenens career.
“Working as a locum would be an excellent way for doctors straight out of training to find out what they want to do and where they want to do it,” Tom said. “I wish this was available when I got out of training because I would have done it then.”
