Solo Practitioners: A New Endangered Species

The decline of solo practitioners in the state.

“Not a day passes where I or others in the group don’t get calls from doctors saying, ‘I need to join,’” says Dr. Robert Brenner, chief medical officer at the Summit Medical Group, the largest doctor-owned multi-specialty practice in New Jersey.

Based in Berkeley Heights, Summit employs more than 300 physicians and other practitioners  who “support 70 medical specialties,” according to its website. As with large multi-specialty practices elsewhere in the nation, Summit’s core philosophy is that the higher the level of coordination, the better and more cost-effective the patient care.

The lesson for doctors is, don’t go it alone. “It’s hard for a one- and two-doctor practice to manage all the business demands of the health care system now and also treat patients,” says Mary E. O’Dowd, commissioner of the New Jersey Department of Health and Senior Services.

It’s also hard, she adds, for smaller practices to marshal the IT and other resources they need to achieve the level of coordination that modern health care demands.

For these and other reasons, doctors fresh out of training—and even mid-career doctors—are bypassing private practice in favor of employment opportunities within larger systems. Many now work for hospitals, which are busily recruiting them, but more and more are looking to join physician-owned group practices. These offer many of the resources of a modern acute-care facility, with the added benefit that the men and women in white lab coats are the ones holding the reins.

The new mega-groups are better able to mobilize electronic health records to enhance communications, keep primary-care doctors informed following a referral, and avoid duplication of services. Total coordination is the goal, but Brenner says in many places it is still more the exception than the rule. “Right now,” he says, “you have people getting out of the hospital, and there’s no communication back to their primaries.”

Is a clash with large hospital systems inevitable as more doctors band together in doctor-owned, multi-specialty mega-groups?

“In our case, it’s more like ‘coopetition,’” says Brenner. “We compete on some things, like services and grabbing up lots of doctors, but we cooperate on other things that only an acute-care setting can provide."

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