Are independent medical practices an endangered species?

Throughout the years, healthcare experts have speculated that one day all private medical offices would evolve to become 100-plus-provider megapractices, or that all the solo docs would get snapped up by hospitals offering employment contracts. And if independence stood any kind of chance, it would exist for physicians solely in the form of concierge or boutique practice.

So far, all of these models have coexisted with traditional medical practices without managing to take them over. But with a new generation of physician pressures spurred by health reform [1], will such a potent array of less-stressful alternatives finally converge to wipe out mom-and-pop doctor's offices as we know them?

A spate of recent articles have profiled physicians who have gotten tired of waiting to find out when exactly their Medicare pay [2] would be slashed or, at best, temporarily frozen (let's say chilled), and eschewed third-party payers almost entirely. Concierge doctors like Dr. Edwin Anderson Jr., [3] a primary-care physician and co-founder of Heritage Medical Associates in Tennessee, have fed reporters similar quips along the lines of "finally being able to practice the kind of medicine they went to medical school for"--spending more time seeing patients and less wrangling with paperwork. While most VIP docs add a caveat that providing 24/7 access to even a limited number of patients is not for everyone, I have yet to read or hear of a doctor running screaming from retainer medicine.

And although the plight of primary-care physicians [4] gets most of the attention, specialists also seem to be exploring their options. According to a recent survey [5] conducted by MedAxiom, more than 60 percent 150 cardiology practice respondents reported that they have either already fully integrated or are considering integration with other healthcare organizations such as hospitals.

With regard to his practice's operating under an integrated model for over a year, Gregory Timmers, Chief Executive Officer at Prairie Cardiovascular in Springfield, Ill., says that healthcare "in its current form does not work the way it's delivered." He adds, "We are trying to put together a model that will deliver significantly enhanced coordination among all physicians in hospitals, while maintaining the trust-based relationships already established between our doctors and their patients."

The buzz surrounding the demise of the independent medical practice is no longer limited to strictly doctors' circles, either. Even commercial laboratory executives [6] are being warned that "hospitals are on a buying spree to snap up physician practices," potentially reducing the number of distinct clients a lab may serve in a given market. This particular article, and many others, cite the medical-home model [7] as a ray of hope in a dismal forecast for physician practices.

But if even that approach were without flaw, more practices probably would've done it already. The truth is, there's no telling exactly what will become of physician practices. My guess is that they will not grow extinct, but they certainly will evolve. - Deb [8]