Solo practices take a stand against trend to go big

Healthcare reformers need to gather more evidence on how large and small organizations perform in the new framework of quality goals and financial incentives before pushing small practices to abandon their independence, J. Fred Ralston Jr., MD, president of the American College of Physicians, told Medscape Medical News.

"We're not ready to write off the small practices," said Ralston, who supports the basic goals of healthcare reform. "We think there needs to be more than one delivery model."

For example, Ralston and others have noted that computer technology can allow small rural practices to share common employees who tackle quality-improvement chores. That same technology allows independent practice associations (IPAs) to function as group practices, citing the Mesa County Physicians IPA in Grand Junction, Colo., as an example.

Reports of entrepreneurial small practices' demise are greatly exaggerated, agreed Steve Ronstrom, CEO of Sacred Heart Hospital, Eau Claire, Wis., in Becker's Hospital Review. "Because of the way independent medical practices function, these physicians think entrepreneurially," he wrote. "They have very direct relations with revenues and expenses. They are very adaptable to change in the environment in a way that is much more difficult for a large multispecialty group."

And while Portland-Maine practice owner Dr. Cathy Crute told NPR that she has to run a tight ship to keep her office afloat (and loses sleep wondering who will take over her practice when she retires in three years), she and her patients tout the benefits of a small practice. "I think patients love a small practice," she said. "My receptionist can recognize a lot of patients' voices over the phone. They know who they're talking to every time. They don't have to go through a whole chain of command."

Patient Laurie Warhol added, "I just think it's better service to come to the same person all the time and have one person overlooking you."

To learn more:
- read this article in Medscape Medical News
- see this installment in NPR's series about primary care
- check out this piece in Becker's Hospital Review

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