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    As Healthcare Reform Takes Hold, 74% of Physicians Will Retire, Seek Other Alternatives

    Healthcare reform will usher in a new era of medicine in which physicians will largely cease to operate as full-time, independent, private practitioners accepting third party payments. Instead, they will work as employees, as part-timers, as administrators, in cash-only “concierge” practices, or they will walk away from medicine altogether.

    These are some of the findings of a new report commissioned by The Physicians Foundation entitled "Health Reform and the Decline of Physician Private Practice". The report outlines provisions in the Patient Protection and Affordable Care Act and examines economic, demographic and other forces impacting the way doctors structure their practices and deliver care.

    The report offers a road map for where medical practice is headed in the post-reform era, says Lou Goodman, PhD, president of The Physicians Foundation and chief executive officer of the Texas Medical Association.

    Concern about patient care
    "The private practice physician is rapidly disappearing," Goodman notes. "Both market forces and the health care reform law are forcing physicians to find new ways of running a practice. We are extremely concerned about how this will affect patient care."

    Drawing on the perspective of a panel of healthcare experts and executives, the report projects physicians will follow one of four courses:

    • Work as employees of increasingly larger medical groups or hospital systems
    • Establish cash-only practices that eliminate third party payers
    • Reduce their clinical roles by working part-time
    • Opt out of medicine altogether by accepting non-clinical positions or by retiring.

    Survey results in agreement
    The projections are backed by results of a national physician survey included in the report. Of some 2,400 physicians responding, only 26 percent said they would continue practicing the way they are in the next one to three years. The remaining 74 percent said they would retire, work part-time, close their practices to new patients, become employed and/or seek non-clinical jobs. Based on the survey and other data, the white paper projects health reform will worsen the ongoing physician shortage and make it harder for many patients to access a physician.

    In order to illustrate medical practice trends, the report includes case studies of medical practice models likely to proliferate post-reform, including studies of a medical home, an accountable care organization, a concierge practice, a community health center, and a small, hospital-aligned practice.