Physician Foundation Grassroots Report

I would like to bring to your attention a remarkable document. It is a 110 page white paper Health Reform and the Decline of Physician Private Practice.

It is a grassroots report conducted on behalf of The Physicians Foundation by Merritt Hawkins, the nation’s largest physician recruiting firm. The Foundation is a nonpartisan, grant-making organization representing independent practicing physicians in state medical societies.

Why do I say the document is remarkable? Because it puts health reform in perspective. Amidst all the sound and fury about the health reform law, it tells what’s happening to physicians on the ground and where they are on that ground.

Where Doctors Practice

The document notes, for example, where doctors actually practice. To hear health reform critics talk, you would think most doctors do their work in large integrated groups or medical centers. Not so. Most of them hang out in solo or small to medium-sized groups.

• Solo, two physician practices, 32%

• Group practice, 3-5 doctors, 15%

• Group practices, 6-10 doctors, 19%

• Hospital-based, 13%

• Medical schools/university, 7%

• Group practice, 51+ doctors , 6%

• Group/Staff HMO, 4%

• Community health centers, 3%

What’s Happening at the Grassroots

The document observes that “informal reform,” socioeconomic trends and pressures on the ground, are just as important, perhaps even more so, than policies being dictated from Washington as embodied in the new health care law.

These trends and pressures include:

• The replacement of traditional independent practice by consolidated entities – hospital-doctor alliances, larger groups, and emerging models, such as accountable care organizations, medical homes, concierge practices, and community health centers.

• Legal and government pressures fostering and forcing an environment to “comply” with outside authorities and statutes and “improvement” and “compliance” measures.

• Increased demand for physician services in the face of growing physician shortages, especially of primary care doctors and general surgeons, with no relief in sight because of time required to mint new physicians.

• The “imperative to care for more patients, to provide higher perceived quality, at less costs, with increased reporting and tracking demands, in an environment of high potential liability and problematic reimbursement," Many physicians regard these imperatives as "mission improbable," or to use a word that runs through the report, as "problematic."


• The reluctance of Congress to include a “fix” for reasonable doctor Medicare pay, as embodied in the SGR formula, which indicates to physicians that Congress is not on the side of doctors, that health care is too important in the minds of politicians to be left to doctors, and that the viewpoint of doctors in likely to be ignored, further disengaging doctors from the profession and making access to them more difficult.

• Changes induced by reform, both “informal” and “formal” are inevitable and sometimes necessary, but do not bode well for increased coverage, quality, access, and private independent practice survival, which now and in the future, will be required for a high quality accessible health system.

Doctors, conveniently available on the ground and using individual clinical judgment rather than just marching to government mandates, are important, especially when you are sick and need their help.