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Sustaining Your Private Practice

Learning Objectives:
1. Identify ways to mitigate risks to your practice’s sustainability
2. Discuss why private practice is still a viable option for many physicians
3. Describe the importance of leveraging one’s network for their private practice
0.25 Credit CME

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Audio Transcript

AMA STEPS Forward® Series Announcement: [00:00] Hello, and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real-world solutions to the challenges that practices are confronting today--solutions that help put the joy back into medicine. AMA STEPS Forward® program is open-access and free to all at STEPSForward.org.

Taylor Johnson: [00:23] Hello, and welcome back to the AMA STEPS Forward®: Private Practice: Attending to Business podcast, a 10-episode series exploring the business side of private practice. In this series, we talk about how to navigate business operations and practice efficiency solutions to create and support a thriving and sustainable medical practice business. I'm your host, Taylor Johnson, manager of Physician Practice Development at the American Medical Association, and I'm joined by my colleague and co-host Meghan Kwiatkowski, program manager of Private Practice Sustainability, also at the American Medical Association. Collectively, we have two decades of experience in private physician practice, and we continue to support physician practices in our current work at the AMA. Before we start, I want to emphasize that this episode is for general informational purposes and should not be relied on as medical, legal or other professional advice. listeners are always encouraged to consult a professional advisor for any such advice. So the AMA launched qualitative research in early 2020, looking at the factors influencing high-performing private practices. Meghan, can you tell us about the motivation for the team to launch that study and analyze the data?

Meghan Kwiatkowski: [01:38] Yeah, absolutely. Thanks, Taylor. The AMA does a study, it's a biennial study that looks at where physicians are in practice, among a number of other questions. But that particular study showed in 2020, for the first time, that physicians were basically past the tipping point of, you know, a 50-50 split of employed versus independent setting. We know that close to 50% of physicians are working in that private practice setting. And it's a substantial amount of the health care industry that's working in an independent setting. And so a lot of patients who depend on private practice in their community access private practices in order to receive care. That research was really important for us to understand what physicians were doing. This qualitative research really looked at what factors made a practice high performing why some physicians were staying in the independent practice setting versus what external factors maybe were causing them to leave private practice. And so that study really helped to guide us in terms of looking at what physicians were doing in practice, other than just providing clinical care. We're really looking at what they felt made them stand out and be successful. There were two ways in this research that we looked at the sustainability of private practice. The first was that we really wanted to understand if there were common approaches and themes that allowed practices to perform at a high level. And then we also looked at it from the opposite perspective, those practices that were not able to sustain themselves, and what happened there, what caused them to be not as sustainable in the long run. As I mentioned, we really thought it was worthwhile to look into the factors external and internal, around sustainable and high-performing private practices with close to 50% of physicians that are in private practice. Can you, Taylor, maybe potentially reflect on why that number is significant?

Johnson: [03:50] Yeah, like you said, even though we still have close to 50% of physicians that are in private practice. According to the AMA Physician Benchmark study, it was the first time that the data indicated that there are now more employed physicians than independent physicians. And it's concerning to see a shift entirely out of one mode of practice, particularly because many independent practices are a lynchpin for their communities. So it has a huge effect on access to care, health equity, and the overall health care market. I just think private practice really was the backbone of the American health care system. And now we are completely shifting away from that. And so Meghan, I know our leadership and our mentors always point out that when it comes to private practices, there is not one size that fits all. So can you explain to our listeners, what is meant by that and why that is?

Kwiatkowski: [04:57] It really is very true, and I think you would probably agree with this, Taylor. When you've seen one physician practice, you have seen one physician practice—each physician practice is going to have different needs in all areas of what they're doing. For example, if you're an ophthalmologist, and your experience, I think would be able to talk to this a little bit in specifics, but you'll need additional testing and procedure equipment like imaging and laser machines. A primary care doctor or cardiologist will need completely different resources to effectively treat patients. And it's the same as when we think about other areas of private practice as well. Certain offices might require additional clinical support staff or procedure- heavy practices might need additional administrative support staff to handle the prior authorization workload, as… Then you also need to consider the location of the practice as well. Certain states might have different regulations than others, and that will result in different needs, certainly, as well.

Johnson: [06:00] I just really like your opening and your opening sentence to answer that question. When you've seen one physician practice, you've seen one physician practice, and it could not be more true when, even when you're within specialties or subspecialties. They are all so different, depending on the population that you serve, and even depending on the physician that's in clinic that day. So I just think it's…it really is so important to understand that they are all very different, even when you're looking at things that may seem like they should be the same.

Kwiatkowski: [06:34] Absolutely. And you know, we're talking about the differences between practices. But can you maybe talk about some of the shared attributes from the practices that were discussed in the survey?

Johnson: [06:47] Yeah, so shared attributes across the practices are really the usable lessons learned that others might want to apply in their own practice. So some of these examples are the ability to stay on top of their clinical game while still running a business. So you have to stay up to date with what's going on in the world of medicine and some of the new treatment options and studies that come out. But then you also need to really pay attention to your business and stay on top of the new recommendations from a business side. Another thing that the survey revealed was that the ability to make decisions quickly is very important to the success of private practices, private practice is unique, and that they don't have to cut through red tape to make decisions, right, like there's not really a higher administration or anything like that, that they have to get approval on. It's really just the administrators and the physician owner in the practice. And that allows them to move very quickly. The ability to make these decisions and make well-informed decisions is really important. And the presence of real pride in the practices that these physicians were growing, and wanted to see last, even beyond retirement, was so apparent in the practices that were successful. You really, really have to have a passion and really believe in what you're doing.

Kwiatkowski: [08:22] Yeah, I think that that's so true. And the one thing that I'll add to what you've listed, all of which are important, I think the other thing that we saw, that was shared across the responses from the practices in the survey was that they often felt like they were on an island, they were men and women unto themselves. And that is obviously not the case. They have peers, but sometimes it can feel that way when you're trying to keep the doors open and really provide care to your patients. And maybe you run into a situation that you don't know what to do. And the so all of that to say [sic] is that, all of the things that you mentioned about staying on top of the clinical game and making quick decisions is extremely important. But it doesn't necessarily mitigate the fact that sometimes you can feel like you're on your own trying to make all these decisions quickly.

Johnson: [09:21] Exactly. And feeling like you're alone might seem like a downside, but some people might like that. But some of the other potential downsides--things like considering that it really might be high risk to have your own practice—can you kind of expand on what are some of those potential downsides in today's private practice landscape and give maybe some considerations for the physicians that want to go into private practice on these downsides, and how maybe they can turn them around before they become a burden?

Kwiatkowski: [09:58] Yeah, absolutely. And first of all, there's a risk, no matter what practice setting that a physician goes into, I think no matter what you do, there's always going to be some inherent risk, no matter what you choose to do. But being a solo practitioner certainly feels like it is very high risk. But some of the ways that you can balance that is to evaluate the support from your community and those that you could potentially be working with to help you grow your practice. And I mentioned sort of feeling like you're on an island, and there's that inherent concern about failure, but also to the point about community, just remembering that there are other people in your exact situation. So community doesn't necessarily have to just mean, who was in your immediate geographic area? Are there people that you graduated with, that you did your residency with, that maybe are in similar situations? Are there online resources that you can access to help you mitigate some of the risk there and answer the questions that you might have? Are there ways that you can engage with your community members, doing outreach at local schools or local businesses, reach out to advisors that you've had in the past, professors that you've had that can help you with the business side of your practice? And then finally, who will you work with? What is the quality, the reliability, and the congeniality of what your team looks like? Those are things that you certainly want to consider as you build out your private practice as you hire in. We've talked about staffing and workflow. You really want to ensure that, as you build out your practice network of team members, that that is a consideration…that you consider the ways that you'll be interacting with the people that are part of your practice.

Johnson: [11:54] Can you talk to us a little bit about what opportunities arose from the research to support private practices just from an overall health care landscape? And then specifically, how is the AMA addressing these opportunities?

Kwiatkowski: [12:14] Yeah, of course. So there's a huge opportunity to leverage electronic health systems. I think many of the high-performing practices from the research, they told us that they were not necessarily using their EHRs to full capacity. And I think once you begin doing that, and use it using your EHR as a support system, and looking at it from that lens as a program that can help you as opposed to hinder you, I think it really took them to another level. And then another thing that some of the opportunities that arose was leveraging economies of scale, and negotiating being part of a larger group, something like an accountable care organization, or an independent physicians association, something just to have the power of a large organization behind you. But yet, you're still remaining independent.

Johnson: [13:04] Yeah, and I think that is such an important point. Because I think that there's a really common misconception that if you're a part of an accountable care organization, or an independent physician association, then you are employed by them, but you can actually remain independent and just be affiliated with groups like this.

Kwiatkowski: [13:28] Absolutely. And I think, you know, even though we're seeing the number of physicians in private practice declining over the past 20 years, there are still a large amount of physicians who are in this private practice model, which I think really says something. And so the AMA has really made private practice and the sustainability of the model an enhanced priority over the past several years. And we've produced a number of educational resources for private practice, and created membership partners with organizations that are beneficial for private practice. And then also really launched several advocacy efforts to support private practice physicians specifically. And so private practice is a crucial piece of the American health care system, which I think you've said, Taylor, and it's important that the AMA can continue to support and sustain that model.

Johnson: [14:19] Yeah, we've really been working to develop a lot of resources specific to physicians that are in private independent practice. So you know, recognizing that the AMA, we represent all physicians, that private practice landscape really is different. And so we wanted to make sure that we had content specifically for them. So I know we mentioned in our last episode, the AMA STEPS Forward®, Private Practice Playbook. Can you expand a little bit on that since I think that really is the foundation of all of our work and it really has a ton of great information in there, and links out to deeper dives and things like that. So can you just explain to our listeners what that playbook has for private practices?

Kwiatkowski: [15:09] Yeah, absolutely. The private practice playbook aggregates a number of existing resources that the AMA has but also includes information from our combined experience, Taylor being on the business and operation side. It includes resources for physicians that are already committed to private practice, who want to improve their efficiency, grow their practice, and learn more about those business issues--topics like revenue streams, collaborating with payers, social media, marketing, and ways to build relationships in your community. One other thing I do want to mention, we have resources for physicians who are looking to engage with their physician peers as well, learning cohorts called Private Practice Simple Solutions.

Did you want to talk just a little bit about that before we wrap up today's episode, Taylor?

Johnson: [15:58] Yes. So they are sessions that are various links long and present topics that are relevant to private practice. We do have a subject matter expert for each session that will go through the content. But then there's also an asynchronous discussion board that comes with this session. And it allows physicians to interact with the subject matter expert, but also interact with their private practice physician peers that may have had success with this topic, if you're really wanting to understand how this works in practice. For some of the topics, the subject matter expert will actually do a second recorded video, really deep diving into some of those issues that we saw on the discussion board that physicians were having when they were trying to implement these different topic areas in real time. And so much like the playbook, a lot of these topics center around operations and efficiency, and they are on the easier side to implement. So the idea is that the physicians will be able to see real time results quickly with the implementation of the content that we're presenting in the simple solution sessions.

Kwiatkowski: [17:24] Yeah, and it's a relatively new resource too. And so I think more to come from the few sessions that we've had. But so far, so good. As we wrap up today's session, Taylor, is there anything else that you want to add in terms of how physicians can be successful in sustaining their private practice?

Johnson: [17:44] I'll just add that we will put some links in the podcast description. And all of these resources that we mentioned are available on the AMA website. But thank you so much, Meghan.

Kwiatkowski: [17:56] Thank you, Taylor. This has been another great discussion, and I'm excited that we have the opportunity to share these discussions with our listeners.

Johnson: [18:04] The tools and resources mentioned in today's episode are linked in the podcast description and available on the AMA website. CME is also available for this episode on the AMA's Ed Hub, and linked in the podcast description. I'm Taylor Johnson and this has been Private Practice: Attending to Business. Thank you for listening.

AMA STEPS Forward® Series Announcement: [18:23] Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA's STEPS Forward® program is open-access and free to all at steps forward.org. STEPS Forward® can help put the joy back into medicine by offering real-world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® podcast series, STEPSForward.org.

Audio Information

Credit Designation Statement: The American Medical Association designates this enduring material activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

 Thriving in Private Practice. American Medical Association. https://podcasts.apple.com/us/podcast/thriving-in-private-practice/id1625133504

Disclaimer: AMA STEPS Forward® content is provided for informational purposes only, is believed to be current and accurate at the time of posting, and is not intended as, and should not be construed to be, legal, financial, medical, or consulting advice. Physicians and other users should seek competent legal, financial, medical, and consulting advice. AMA STEPS Forward® content provides information on commercial products, processes, and services for informational purposes only. The AMA does not endorse or recommend any commercial products, processes, or services and mention of the same in AMA STEPS Forward® content is not an endorsement or recommendation. The AMA hereby disclaims all express and implied warranties of any kind related to any third-party content or offering. The AMA expressly disclaims all liability for damages of any kind arising out of use, reference to, or reliance on AMA STEPS Forward® content.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Enduring Material activity for a maximum of 0.25  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 0.25 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 0.25 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 0.25 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 0.25 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 0.25 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.


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