Editor’s note: It is my pleasure to introduce this new quarterly column in The New Gastroenterologist that will be dedicated to addressing important topics for early-career GIs who are either considering a career or starting a career as an independent GI physician in practice. This column is a collaboration between the AGA’s The New Gastroenterologist and the Digestive Health Physicians Association ( ), a national advocacy organization of more than 1,800 gastroenterologists in 79 member practices, which is focused exclusively on policies that promote and protect the high-quality, cost-efficient care provided to patients in the independent GI-practice setting.
Bryson W. Katona, MD, PhD
Editor in Chief, The New Gastroenterologist
Educating and training for your life’s work has likely occupied much of the past 10 years including medical school, residency, and fellowship. When it comes to deciding the next steps, the options can seem daunting.
As a long-standing private practice gastroenterologist, I think it is important for early-career GIs to understand the different private practice options and the new challenges and opportunities that private practitioners are experiencing.
According to recent data, there are approximately 12,500 clinical gastroenterologists divided among private gastroenterology practice models, hospital-based employees, and large multispecialty groups. There are nearly 6,000 private practice gastroenterologists.
There has been ongoing dialogue among all health care system stakeholders and the public regarding health care delivery, access, and financing. For the past several years, private practice advocacy groups, including DHPA, have been urging the elimination of the Medicare “site of service” differential between hospital and nonhospital settings, which typically results in substantially higher costs for hospital-based services.
In the 2015 Balanced Budget Act, Congress mandated that patient services provided in off-campus locations acquired by hospitals after Nov.1, 2015, be paid at the nonhospital rate. The 2019 Medicare Outpatient Prospective Payment System/Ambulatory Surgical Center proposed rule takes additional steps in achieving site neutrality and will likely have the effect of tamping down hospitals’ incentives to acquire independent physician practices.
This is a positive step forward in preserving the cost-efficient, high-quality care provided in the independent GI medical setting. And, with the growing health needs of an aging population and an aging GI physician workforce (nearly half of gastroenterologists are older than 55 years old), there is sure to be an ongoing high demand for providers in our specialty.
Selecting the career path that best fits your goals, ambitions, and lifestyle can be challenging. But, our professional training has taught us that the best method for arriving at the correct course of action is to first understand the questions and then seek the answers – let’s get to it.
Private practice models: What are the options?
A lot has changed since I completed my fellowship training in 1978. But the most dramatic changes have happened in the past decade, including the trend of smaller practices consolidating into larger groups.
Traditionally, physicians and patients have favored individual and very-small-group practices. Patients view small-group practices as highly personalized. They come to appreciate knowing all the physicians and staff in a practice. These long-standing “family type” relationships among patients and providers that often develop in this clinical care setting engenders in both the patient and provider a high level of satisfaction with the type and experience of care provided.
New physicians who are part of a small group practice often have the opportunity to take an earlier and more active role within the leadership of the practice. Small groups typically look to new physicians to function as “innovators” who can introduce into the practice those cutting-edge treatments and procedures learned during fellowship.
In the past decade, however, the trend toward the disappearance of solo and very-small-group practices has accelerated. Today, very small groups face several challenges. Providing all the “necessities” that are now part of today’s medical practice can be daunting. Small-sized practices are less likely to integrate ancillary services (e.g., lab and pathology services, in-office infusions, dietary and weight loss management) that are more typically seen in larger practices. Patients may find this fragmentation of care burdensome when they have to go to several providers for treatment.
The difficulties of implementing and maintaining information technology, EHRs, and patient-engagement tools are often inversely related to group size. In addition, the ability and effectiveness of a group to negotiate with hospital systems and insurance companies can be easier for larger practices, although other local factors will also come into play.
Beyond the administrative aspects of running a small group practice, your views about work-life balance should also be an important consideration when choosing a career path. Understandably, issues of call coverage and time off can be more restrictive in small groups.