Private-practice doctors fading in Sonoma County
By Guy Kovner, The Press Democrat, Santa Rosa, Calif. | |
McClatchy-Tribune Information Services |
He logs nine hours of patient care in his office and at
All day Thursday is devoted to the administrative chores of running Sonander's solo medical practice, privately owned and standing apart from the group model that now dominates the American medical profession.
"I'm in charge of my own office," said Sonander, who has practiced medicine here since 1989 and was previously in a group for 10 years. "I control my own workload. I feel like I have a little bit more freedom in the style of my practice."
But the downside to solo practice, he acknowledged, is a burgeoning mass of paperwork -- insurance billings, medical records and the responsibilities of a business owner -- that may eventually force him back into a group that handles those details and leaves physicians largely free to practice medicine.
Sonander said he is part of a "fading breed."
Others say he is a dinosaur, stubbornly holding onto a business model that flourished 30 years ago but is now ebbing fast.
"I don't know how Jan does it," said
Medicine today is a "totally different world" from what it was three decades ago, Keiser said. The days of a lone private physician hanging out his or her own shingle are long gone, he said.
There's no exact count of solo practitioners among
But 560 physicians belong to the county's four largest medical groups, another 123 work for community clinics and government agencies and most of the remaining 378 are in groups of fewer than 40 doctors, along with a small number in solo practice, according to the
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Applied to
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Three decades earlier, in 1983, 40.5 percent were solo practitioners, and by 1994 the percentage had fallen to 29.3 percent, the AMA report said.
Physicians and experts cite two factors for the steady disappearance of the old
The process of billing and obtaining reimbursements from
Private insurers like
"If you don't have the paperwork filled out 100 percent right, it is not paid and it gets kicked back to you," Keiser said.
The Affordable Care Act mandates that physicians maintain electronic medical records systems, more of a burden for a solo physician than a group, said
"You end up giving up your autonomy" by joining a group, said Steady, president of the
It's easier for a specialist to work solo, rather than a primary care physician like Sonander, Steady said. His income from office procedures enables him to hire a third party to handle billing and employment services.
"I can work as hard as I want or as little as I want," said Steady, who said he works 50 hours a week.
Health care providers "have to be bigger and better organized" to cope with pressure from insurers to clamp down on reimbursements, said
"It's hard to be in solo practice unless you're someone who likes the business end of it," she said.
Surveys by
The firm's survey of final-year medical residents in 2011 found that 32 percent wanted to be hospital employees, up from 3 percent in 2001, and 48 percent wanted to be in partnerships or groups. Only 1 percent wanted to work solo, down from 8 percent in 2001.
Nearly half (48 percent) cited "availability of free time" as their greatest concern upon entering medical practice, up from 33 percent in 2008.
Residents in 2011 ranked "dealing with payers" such as
Nearly half of the 2011 residents (48 percent) said they felt unprepared to handle the business side of medicine, compared to just 18 percent in 2008.
A decade ago, residents told recruiters they wanted to "put down roots" and buy a practice, said
Today's residents ask recruiters: "What's my salary and how much time do I have off?" he said.
They are no less dedicated, but they want work-life balance, especially in
In 2001, 22 percent of
Solo practice is a "dinosaur that has almost gone extinct," Miller said.
A survey of 3,400 physicians statewide found the lowest percentage of solo practitioners in the
Those two areas also had the largest presence of
In
Kaiser's appeal to physicians is a salary and generous benefits, free of all concerns over billing and insurance.
"It's pure medicine," said
"I get to stop wrangling with ICD-9 (insurance) codes and fighting with insurance companies," she said. "I can go to sleep at night."
Even in a group practice, Mortensen said it was a challenge to deal with six different insurance carriers. "It felt like it was a contest to wear the doctor out," she said.
Rounding out the greater
The consolidation of
As much as he values his independence, Steady said he can see an end, or a reduction, of his solo practice as medical groups absorb the primary care physicians he depends on for patient referrals.
Ultimately, American medicine will end up with a fully integrated system like Kaiser, with a single payer replacing for-profit insurance companies, Steady said.
"How are you going to decrease costs?" he said. "You take out the middle man."
Sonander said he thinks there will always be a place and a patient demand for private physicians.
"I say I'm a one-man integrated system," he said, noting that he follows patients from their homes to the hospital, nursing home or hospice care.
But he also acknowledges that one day, when
"I haven't ruled that out at all," Sonander said.
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