Solo practices show promise to persevere


“Genius is 1 percent inspiration, and 99 percent perspiration.”

Thomas Edison knew a few things about smarts and sweat. Such are the results of producing and securing a reality for one’s inventions, after all. And like Edison, solo practice physicians put their blood, sweat, brains and dollars on the line to promote a bright idea — the one that finds paramount value in personalized, albeit far-reaching, care.

Amidst an economic disaster and healthcare overhaul, the death of this yeoman physician — the white coat who shoulders rent, staff and administrative regulations whilst still tending to the sick, huddled masses — has been uttered the industry over as nigh. Yet, regardless of how many of doctors move onto acquisitions or the success that PCMHs and other hybridized care models seem sure to have as they develop, it’s pretty safe to state firmly the following: Solo practices will always be around.

As long as there is entrepreneurial vigor to be found in the men and women of medicine, there will be physicians prepared and dream-driven to serve their career days as both MD and MBA.

But don’t take just my unpracticed word for it. Consider this guy:

“Historically, physicians have been small-business men as well as healers, and small-business men are nothing if not innovative,” Jeremy A. Lazarus, MD, president of the American Medical Association, wrote in a column for American Medical News. “So long as there are physicians, I am confident there will be entrepreneurial types and others who seek the autonomy and satisfaction of running the show themselves.”

“And that makes me wonder just how much about the demise of solo or small group medical practice, in Mark Twain's classic rejoinder to news that he had died, has been 'greatly exaggerated,'” Lazarus went on.

In moments of hardship and moments of great creative stride, there will always be hyperbolic talk of doing away with the traditional. Yes, hospital acquisition can be financially savvy given that huge chunks of change — such as the $82,975 per doctor spent by private practices to deal with just insurers — will be bills footed by a bigger boot. Yes, being part of the PCMH or ACO yolk is fun and offers a lot of exciting, new avenues to achieve collaborative, holistic care. But the natural impulse to promote one’s new practice solution, to be passionate about it, doesn’t have to involve denouncing the old on unproven grounds.

If we’re down to only 60 or 2 solo practices in the nation, we still shouldn’t shout extinct until the species is no more — it’s just proper rhetoric. Rare the choice may be, we’re still far from seeing the last individual practice. Even with just one third of all doctors being independent (as predicted in 2011 by Accenture to be the case for 2013), that’s still a lot of specimens to fill the genus.