Surviving, Thriving, as an Independent Physician

Many physicians today are faced with the difficult decision of remaining in an independent practice or accepting an offer to be bought out (swallowed up?) by a hospital or large medical group. It would seem physicians are caught between the proverbial rock and a hard place.

While many are attempting to determine whether selling their practice makes financial and professional sense, there are others who are bucking the trend. They’re swimming upstream, against the current, and leaving larger health care organizations to start their own practices.

One of them is Craig Pope, MD. And his decision-making process, at least initially, was not financially based.

“I’m a strong advocate of the patient-centered medical home,” Pope explains. “It really felt like the constraints of hospital-based medicine required me to do things that were not necessarily in the patient’s best interest.”

Taking responsibility

Pope says that one of the reasons why he didn’t work well as a provider in a hospital setting is because he believes in taking responsibility. When the organizational restrictions within which he had to work caused the gears to gnash, that’s what gave rise to his frustration and, ultimately, the decision to be independent.

Pope says that his decision stemmed from the freedom to act on the responsibilities that he already felt for his patients, as well as the opportunity to run an office the way he thought it should be run.

But Pope also acknowledges that there’s a price to be paid for that responsibility.

“The biggest challenge to a provider is picking up the administrative sides of the practice,” Pope says.

In addition to the same workload of seeing patients and providing good evidence-based care, Pope also has to train employees so that they understand the jobs they are expected to do and can do well. Furthermore, he has to be sure that liability issues are addressed and that all the gears of an independent practice are running smoothly.

“There’s a lot more to pay attention to,” Pope says.

Friends, allies, and finances

Pope opened his practice, Dillon Plaza Family Medicine, in High Ridge, Mo., three years ago, and one of the first pieces he added to the practice was United Allergy Services.

“I was referring to allergists, and my patients were all coming back and hadn’t gone, or had fallen through on their treatment,” Pope recalls. “It was something I was able to incorporate into my practice so that [my patients] got the treatment that they needed, and it was also an important income opportunity for my practice — one of those rare situations where it was win-win.”

However, Pope stresses that there was more to the decision to bring in United Allergy Services than simply financial incentives; he had to consider patient expectations, which are higher than ever. Patients are smarter consumers now when it comes to health care than they ever were in the past, Pope explains.

“They’re looking for providers who are attentive to that,” he says. “And United Allergy Services’ lab is right here in my office so I don’t physically have to send [patients] somewhere else. That’s all very attractive, and, honestly, I haven’t done hardly any advertising outside of my office. It’s mostly word of mouth, and we’ve grown. I think the best way I can say it is about 12% of my visits are new visits.”

Trust your heart

Pope acknowledges that a key to remaining independent is the relationships physicians need to build with outside entities — workflow support, information technology, billing and coding. He says that working with United Allergy Services has been critical to his practice’s success, and allowed him to differentiate himself from being a typical provider.

“I believe [the alliance with United Allergy Services] literally makes the difference between me being viable as a practice and financially going upside down,” Pope says. “I don’t think I could do it without something like that as a piece of the entire business plan.”

But the first hurdle physicians need to clear, Pope adds, is to examine what’s in their heart; trust the desire for what they truly want to do.

“If the independent model isn’t something that speaks to a provider, all the rest is moot,” he says. “The one thing I would volunteer along with that, the one thing I feel badly about on behalf of my peers, is the misrepresentation that is made by organized medicine that clinicians need them to survive. There is a message out there of health care reform and the move toward outcome-based models that the independent physician simply cannot survive without the medical group. And I think that’s a gross misrepresentation of the facts.”