Two Primary Care Things

You will see something new

Two Things. And I call them

Thing One and Thing Two.

Dr. Zeuss (1904-1991), The Cat in the Hat (1957)

Two Things loom on the primary care horizon.

Thing One, physician employment is documented and hot, as evidences by a 2014 Merritt Hawkins Survey. The Survey of 3158 physician searches indicates hospitals, medical groups, and other entities hire 9 of 10 primary care doctors being recruited.

Thing Two,direct pay/concierge practices, is not documented because most primary care physicians entering direct pay/concierge practices do it on their own without going through recruiters. Thing Two may or not be hot, but it seems to be on everybody’s lips as the coming thing.

Of Thing One, Travis Singleton, senior vice president of Merritt Hawkins, comments:

Travis Singleton, senior vice president at Merritt Hawkins, says Thing One results primarily from hospitals’ response to ObamaCare which emphasizes population health and value-based care, and the growing importance of market share and leverage with payers is spurring much of the trend toward physician hiring.

"Everyone has glommed on to the employment model; physicians because they are trying to mitigate risk and they are looking for financial help and they have all the issues of medicine and small business concerns," Singleton says.
"On the other side, whether you are a hospital, urgent care, concierge or some mix thereof, it enables you better to influence the behavior of your clinicians. And increasingly, in all of these delivery systems, that clinician is not just a physician. It's a team health environment… and the only clear mechanism that allows you to push all those different cultures and providers and modalities in one direction is employment."

Well, that may be. It may be the hospitals and primary care practitioners think employment is the way to go. And it may be that employment is an inevitable trend.

But it also may be that sizable numbers of primary care doctors think differently. Thing Two is very much on the minds of some 10% to 14% of primary care physicians who are thinking about making the switch. Singleton is aware of this contrary view.

A notable exception to the shift toward employed physician models is the rise in concierge practice. Merritt Hawkins conducted 32 searches last year, up from 10 searches two years ago. Singleton says his search data probably under reports the move towards concierge services because recruiters often aren't needed.

"If you are a provider who is fed up, whether it's your legal costs or compliance or the business of medicine itself, the easiest shift you could make is to become a concierge physician," he says.

"We are seeing some of the same trends in urgent care and freestanding ERs towards convenience medicine," Singleton says.

"People are coming to understand this consumer-driven, convenience care area of medicine and the push to outpatient care. Concierge is a good reflection of that. Healthcare for so long has been insulated to the consumer. They haven't had to appeal to the consumer like they do now."

In my new E-book, Direct Pay Independent Practice: Medicine and Surgery (DRG Publications, St. Paul, Minnesota), I discuss prospects for independent pay in the primary care and surgery sectors. The book is based on a keynote address I gave before the American Association of Physicians and Surgeons in May 2014 , on a series of blogs I have written on the subject, and on 12 interviews I conducted with physicians and others involved in the independent practice movement, i.e., practice devoid of third party arrangements with health plans or government programs. Several of those interviewed predicted within 5 years, 80% of primary care doctors will be in independent pay practices.