‘Independent medical practices are not dead’

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The new American Independent Medical Practice Association (AIMPA) launched in October to be a new voice for independent doctors across all specialties, including primary care, internal and family medicine.

The organization started with almost 5,000 members who provide health care for 10 million patients across 39 states. Those physicians are united by a passion for quality patient care that is accessible, cost-effective, and unburdened by layers of health system bureaucracy.

“Independent medical practices are not dead,” said AIMPA inaugural President and Board Chair Paul Berggreen, MD, a gastroenterologist practicing in Phoenix, Arizona.

Paul Berggreen, MD

“We have some very smart physicians who are very much determined to remain independent, and are also very much in the mindset of protecting our profession and our patients and delivering the care that we want to deliver, the way we want to deliver it, because we know that's a great way to practice medicine,” Berggreen said. “We're here, we're going to grow, people are going to hear about our message. And I think it's going to be remarkably well-received by patients, by physicians and by policymakers.”

Berggreen introduced AIMPA and discussed independent practice with Medical Economics. This interview was edited for length and clarity.

Medical Economics: What's your favorite part about being an independent practitioner?

Paul Berggreen, MD: My favorite part of being independent goes with my favorite part of being a physician: talking to patients, interacting with patients, getting to take care of an entire family. You do a good job for the mom and suddenly you're seeing all the kids and 30 years later you're taking care of the kids’ kids and that's actually fascinating. I enjoy that. I've always been in independent practice. I get to take care of those patients, interact with them on my schedule, the way that I was trained to do it, the way that I've found that it works better with my delivering care to my patients. That's actually what keeps me going, that personal interaction. I think being in independent practice has kept that going for a lot longer. You get to go to work, you chart your own course, you take care of the patients the best way that you know how, you respond to needs, you respond to them quickly and efficiently. It really is the modern-day equivalent of the old-time family doctor that used to just sort of do whatever he or she needed to do for their patients. That's actually what I think is the most fun. I will tell you that I've also gotten more in tune with some of the policy objectives of the health care system in general and how we can improve the care that we deliver to patients, regardless of your practice setting. But specifically, I look at that from the lens of the independent practitioner and say, you know, there's a lot of things that are out there that we can improve, and we have the flexibility and the nimbleness to do so. So that's actually been a priority of mine for the last number of years now.

Medical Economics: There already are a number of physician organizations devoted to various aspects of medical research, medical practice and the business of medicine. How do you explain or define AIMPA’s role?

Paul Berggreen, MD: To my knowledge, there’s never really been an organization that's focused really about independent practices of every specialty. A lot of specialties have their own advocacy organizations, certainly. I'm a gastroenterologist and we have ours and we talk about issues that are specific to gastroenterology. But there really needed to be an organization that spoke on behalf of private independent practice exclusively because the landscape has changed in health care, and it's been a remarkable change. In the 80s, when I was in medical school, about three out of four physicians were in independent private-practice medicine. Three out of four. In 2021, that was one out of four. That's shocking. And what you're seeing is that some of these policy initiatives from the government, some of the market forces that exist, some of the consolidation among hospital corporations, has led to a change in the playing field from an overall strategy standpoint for the profession of medicine. It got tilted in favor of hospitals basically swallowing up medical groups and taking advantage of some of those works and laws that may have been well-intentioned, but it worked out to be disadvantaging independent practice of medicine. We're trying to change that. We specifically went across every specialty that we could find to say, look, are you guys facing the same challenges? And it turns out, everyone's thinking the same thing, but there was no organization that represented us. And you look at some of the other organizations that are multispecialty, they really have a broad constituency. They may represent independent practices, employee practices, academic practices, et cetera, and maybe offer other services. We're really laser-focused on issues that are important to independent medical practice.

Medical Economics: Hospitals and health systems may be huge employers and may promote physical and mental health in a community. Those are certainly important functions. How do independent medical practices bring value to patients and communities compared with consolidated hospital care?

Paul Berggreen, MD: I'll go back to three things. We need to focus on this: quality, access, cost. We want to deliver the highest quality care that we can, and studies have been done, and they're out there in multiple specialties, to show that care delivered in the independent medical practice setting is no different than care delivered by physicians in the hospital setting. There's no demonstrable changes in quality. Accessibility is a big one because in general, in private practice, we accept all insurances including Medicaid and we have multiple offices in the community. In general, we're spread out, we serve the communities in which we live, and so it's much more convenient. Here's an example. You come to my office, you park right outside the front door, you walk up to the second floor, and that's where my office is, and that's where a lot of us are. We're your local physicians. You don't have to drive onto a hospital campus, park in a parking garage three blocks away, pay $10 for parking and, and navigate your way through a maze to get to your doctor's office. So, there's a convenience factor as well. But one final issue that I talked about is cost. There are numerous studies out there that show that care delivered to patients in independent medical practice settings is significantly, up to 30%, less expensive than care delivered in the hospital-based setting. A number of factors contribute to that. But those numbers are out there and that's our experience as well.

Medical Economics: How will AIMPA work to inform patients and policymakers about the importance of independent medical practices in providing high-quality and cost-effective care?

Paul Berggreen, MD: Our focus right now is actually on policymakers. We need to make sure that policymakers are aware that private practice, independent medical practice is alive and well, and that we are an integral part of the communities in which we are based, in the patients whom we serve. We were on Capitol Hill recently talking to multiple members of Congress. We found very receptive audiences to this. People will say, look, these physicians are important, integral members of the medical community and they are shrinking – different rates of contraction among different specialties, but they're under threat. That does not serve the health care system well. So, we found receptive audiences with policymakers. And it's funny because a comment that we got repeatedly by several members of Congress is, where have you been? It was, oh, wow, it's great to see an organization that's here, that represents what we've been thinking as well – where's the counterbalance to the hospital systems? Well, we've been here all along. We'll say that physicians have been slow to organize and slow to mobilize. And that's historical, right? We're physicians, we're busy taking care of patients in our offices, and then we do other stuff at night, so that's the dynamic. But we have organized and we are mobilizing now and that's to get our message forward to policymakers first, local community outreach second, to let people know that, hey, our practices are still here, we still take care of 10 million patients a year. That's not an insignificant number of the health care requirements in this country. And we're growing. We can even talk to other groups of all specialties, including primary care, to say, this is what AIMPA is, this is what we do, and do you feel it's valuable to join us? What we're getting is a lot of yeses. So, it's very encouraging.

Medical Economics: Our main audience is primary care physicians. What would you like to say to them, or what would you like them to know?

Paul Berggreen, MD: I would say that AIMPA represents an opportunity for those primary care practices that are still out there and still surviving and putting up with challenges, to have a voice along with your specialty colleagues on Capitol Hill. It is not a specialty organization. It is a broad-based organization of essentially all aligned independent specialties. This is an opportunity to build an organization that can actually help to shift policy directives so that independent medical practice remains a viable and healthy alternative and all the downstream benefits of remaining independent accrue to those who did remain independent. So, the answer is, we would appreciate a conversation and a collaboration.