Decades ago, doctors finished their medical training, hung up their shingle, and started practicing medicine. Today, many practice arrangements are available, from hospital-employed to partnerships to solo practice. We can get paid salaries or incentive bonuses or fee for service. However, according to the AMA, the trend for doctors staying in private practices has been steadily declining. In 2018, an estimated 54% of doctors were working in their own practices. That number dropped to 49% in 2020. While no statistics are available for 2022, many colleagues left private practice due to the strain placed on them by the COVID-19 pandemic.
Why we are leaving private practice:
Declining Reimbursements. In the past, we were able to negotiate fees with insurance companies and reach a compromise that both parties found acceptable. Most of us in private practice haven’t seen a fee increase in more than a decade. Yet, the cost of living continues to rise. Additionally, insurance companies can preemptively decide to drop us from their panels for no apparent reason. They’ve been known to do this without notifying us or our patients.
Increased Regulatory Burden. During the past several years, we have been asked to do more to remain compliant with new regulations, from meaningful use to quality incentive programs. All these regulations come with mounds of metrics reporting and data collection. While our reimbursements are declining, a portion of what we get paid is being tied to these metrics. We are doing much more meaningless work for less money.
Insurance Company Hassles. These days, most insurance companies require prior authorizations for many services. We no longer get to order the tests and medications we think our patients need. Insurance companies tell us that they are not practicing medicine, merely making coverage determinations. However, when medical care is unaffordable for patients, they are preventing patients from getting the services they need. So, yes, they are making medical decisions and often delaying diagnosis and treatment. They will tell you that you can appeal their decision, but they will then tell you to wait 90 days for a response. To further complicate matters, generic medications are no longer routinely covered.