Why solo medical practices are on the decline: Guest column

By Dr. Anthony J. Cerone Jr. – South Jersey Times  on January 02, 2015 at 12:40 PM, updated January 02, 2015 at 2:38 PM

Dr. Anthony Cerone is a semiretired urologist and a Clayton resident. His articles appear monthly and deal with health care issues.

Dr. Anthony Cerone is a semiretired urologist and a Clayton resident. His articles appear monthly and deal with health care issues.

My name is Dr. Anthony J. Cerone Jr., but to all of you, my friends, I am simply known as “Doc,” or “Uncle Doc” to the younger generation.

By way of background, I was born and raised in an ethnic middle-class environment in South Philadelphia. My active medical career spanned approximately 30 years as an urologist in the Philadelphia/South Jersey area.

Currently, I consider myself “semi-retired” and do administrative work in medicine involving quality improvement, medical utilization, and medical review.

I would like to use this column as a forum to educate you about issues that concern us all regarding health insurance, managed care, quality of care and the like.

Certainly with the advent of Obamacare there has been a great impact on these issues and a growing concern and awareness regarding these matters by the general public.

I will not use this column for general medical information about diseases; this is not my intent. I would anticipate that my discussions will “hit home” with most consumers who feel prisoner to rising insurance costs, increasing restrictions on benefits, and an overall sense that the delivery of health care is not as good as it used to be.

For those of you so motivated, please send me an email at concerning any question or topic you would like me to cover.

The Disappearance of Solo Medical PracticesThe holiday season always brings to mind good memories of our childhood. We had Christmas parties, helped mom bake cookies, helped decorate the house, and eagerly awaited all those presents from Santa.

That is, unless we were sick. Then we got an unwelcomed visit from the man with the black bag. To this day I can clearly see him chasing my brother around the dining room table.

Today, with rare exceptions, gone are the house calls, the personal attention, and the faith and admiration that we had in one person, our family physician who took care of all our health matters. Truth be told, just like the mom and pop stores, doctors in solo practice are dwindling in numbers. Large group practices predominate now. Why is this so?

One of the biggest factors discouraging today’s newly trained doctor from going into solo practice is the economics of medicine. In today’s environment, a solo practitioner would spend a disproportionate amount of time on billing, coding and dealing with insurance company issues.

In addition, doctors coming out of medical school today have very little training on how to run a business. In order to avoid these pitfalls and spend most of their time in patient care, many physicians trade their independence by joining large practices, health systems or hospitals. It is estimated that the number of solo general practitioners has gone from 44 percent to 18 percent in the last 30 years.

Economics also favors forming a larger group practice in terms of expenses. Larger medical groups, like any other business, have better negotiating power for higher insurance company reimbursements and lower costs involving rent, malpractice insurance, supplies and equipment. The cost for conversion to electronic medical records certainly favors a larger group of doctors.

Physicians may also prefer the security of a fixed salary and benefits package available in the larger venue. With the advent of the Affordable Care Act (Obamacare), we are seeing the demise of small practices that cannot compete with larger practices when it comes to meeting certain quality and efficiency targets that lead to better payments.

There are also many non-economic factors. I would venture to say that today’s physician is less eager to work or be on call 24/7 than past generations. A higher value has been placed on “my time” that favors forming large groups. Working out of a spacious modern office with adequate parking certainly tops many of the smaller home-converted offices of the past for both patient and doctor.

Larger groups also allow for sub-specialization within the group rather than referral to a large medical center. A large urology group will typically have one or two individuals who deal primarily with pediatrics, infertility, incontinence, stone disease and robotic surgery. So, within a large medical practice, you may need to see several different doctors instead of “your own” doctor.

You may prefer the traditional family doctor model. What can you do? Today there is a form of medical practice called “concierge medicine.” In this system, you will pay fee-for-service and are assured access to a certain doctor “at any time.” Just like old times, right?

Concierge physicians, which number up to 5,000 in the United States, will typically see anywhere from 50 to 1,000 patients maximum. They claim to be accessible by telephone or email at any time of day or night. A patient may pay anywhere from $60-$30,000 per year for “direct primary care.” That’s quite a wide range, which brings to mind the old saying “you get what you pay for.”

Eliminating insurance billing cuts 40 percent of the practices’ overhead expenses, enabling them to keep fees low, doctors say. The majority of patients, however, still carry health insurance to pay for services that their concierge doctor is unable to provide. Some traditional health insurance companies even offer a “concierge option.”

After all is said and done, delivering health care is a business, and like many other businesses, it must adjust to changing times. We miss those house calls, but at this time of the year we also miss our childhood memories of Christmases past along with some of our unique family traditions. Have a happy, healthy, New Year.

Dr. Anthony Cerone is a semiretired urologist and a Clayton resident. His articles appear monthly and deal with health care issues. You can reach Dr. Cerone at with any question or topic you would like him to cover.


Categories: Business, Cost, Trends

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