Exactly six months ago (just after the Patient Protection and Affordable Care Act was signed into law) my first editorial for FiercePracticeManagement probed a question I've nearing for nearly a decade of writing for and about physician practices: What will become of the independent medical practice?

And with the new legislation giving the existing trend toward consolidation a giant shove, the discussion has not let up. In fact, the question is no longer if physicians will stay in small practices, but with Medicare reimbursement constantly at risk, whether they will stay in medicine at all.

According to a recent survey of 2,400 MDs conducted by the Physicians' Foundation, nearly three quarters said they plan to retire, work part-time, stop taking new patients, become an employee, or seek a non-clinical position in the next one to three years. Sixty percent of those surveyed pointed a finger toward health reform for their woes.

"Doctors strongly believe the law is not working like it needs to--for them, or for their patients," said Lou Goodman, president of the Physicians' Foundation.

However, the paper accompanying the report also noted this: "Despite its many problems, healthcare reform was necessary and inevitable and many of the changes mandated by the 'formal' reforms likely would have occurred on their own within the 'informal' delivery of care, owing to economic and demographic forces."

Regardless of the causes, Goodman added, and I agree, physicians will be forced to find new ways to run their practices.

So, assuming FPM readership represents the stalwart field of providers willing to stay in the game, how will you change your strategy for 2011 and beyond?

Are you going to stick it out on your own, join a larger group, go concierge or cash-only, scrutinize overhead, leverage midlevel providers, boost practice efficiency, step up your marketing, roll out new services or some combination thereof?

Although reader comments are always encouraged on this site and those of our sister publications, the insights you provide here will go a long way toward helping us select and create the content that will be most useful to practices like yours facing these unprecedented challenges. So, even if you haven't shared feedback before, use this half-year check-in as your opportunity to speak up! - Deb

P.S.: Remember that this page isn't the only way to reach me. Feel free to send your insights and ideas to @PracticeMgt on Twitter!