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Tuesday, March 11, 2025

Find your freedom: Practical strategies for physicians returning to independent practice

For many physicians, the allure of independent practice is a compelling one — offering the autonomy to prioritize patient care, make key financial and operational decisions, and forge a more personal connection with their patients. However, the prospect of overcoming start-up costs, navigating complex regulatory landscapes and managing a thriving practice can be daunting.

Just ask Daniel Opris, MD, who was working in the hospital and clinic settings within a large consortium in Dayton, Ohio, when he realized he wasn’t happy.

“Between large empanelment sizes, time available to allocate to patient care and overall lack of autonomy, the environment unfortunately hampers personal growth and makes it extremely difficult for providers to deliver care to our patients the way we feel it should be,” he says. “When most days felt like a battle between administration and doing what I felt was best for my patients, I knew it was time to move on.”

So, a couple of years ago, Opris joined Executive Medical Centers of Ohio, a team of three family doctors and internists who all left their roles at large hospital systems in the area to focus on a more boutique, personalized approach to health care that has no affiliation with one specific hospital system.

“The autonomy gained within independent practice allows me and my partners to get back to a grassroots style of medicine where we can combine providing excellent evidence-based care [with] providing patients with the one thing that we felt they are severely lacking within the medical industry today, time,” he says. “As for myself, having a family with young children, work-life balance is extremely important and something I found has significantly improved once I made the transition.”

Annie DePasquale, MD, founder of Collaborating Docs, which has helped over 5,000 nurse practitioners and physician assistants start their own practices, has worked closely with many physicians who have left hospital systems to go on their own.

“A lot of clinicians I’ve worked with have felt that large organizations stifle their ability to provide individualized care or limit their ability to grow their practice in the way they envision,” she says. “The motivation, then, is often driven by a mix of professional burnout, the desire for greater control and the urge to establish a practice that fosters personal fulfillment.”

First steps

For those who transition to independent practice, the biggest challenges are typically financial and administrative.

“One of the hardest hurdles is securing initial funding or navigating the financial side of the transition, particularly if the clinician has been used to a steady paycheck,” DePasquale says.

Other common challenges include setting up a practice management system, establishing a patient base and ensuring compliance with health care regulations.

“There’s a lot to juggle when you first open a practice — such as finding a good location, hiring staff, and implementing efficient billing and insurance systems,” says John Lowe, MD, an internist in Ogden, Utah, who made a switch from a hospital setting to independent practice during his career. “Managing the business side of things is something that clinicians often underestimate when they leave the corporate world for independence.”

When setting up a practice, DePasquale recommends breaking the process down into manageable steps.

“First, it’s important to determine your niche or focus, which will guide everything from your branding to your patient acquisition strategies,” she says. “Clinicians should seek out resources like business coaches or consultants who specialize in health care start-ups, as they can offer invaluable guidance.”

Networking with others who’ve successfully made the transition is another great resource — learning from their mistakes and successes can save a lot of time and money.

“Additionally, it’s important to invest in good practice management software, as it streamlines everything from scheduling to billing,” DePasquale says. “Building a solid team and developing relationships with vendors for office supplies and equipment is another key part of setting up a practice.”

She also recommends outsourcing bookkeeping and accounting tasks, as this can free up time to focus on patient care rather than worrying about financial details.

“Another helpful resource is hiring a virtual assistant to handle nonclinical tasks like patient communications, follow-ups and administrative support,” she says.

Opris notes independent practice won’t eliminate the headaches of dealing with insurance or other regulated facets within the health care system, and may likely add new ones, which often comes from starting or growing a practice.

“However, in my opinion, if more providers are able to take the leap and transition back to independent practice, this has the potential to improve the way health care is delivered and refocus priorities where they should be, on the patients, while also allowing providers to take better care of themselves,” he says.

Lowe notes it’s vital to have the proper knowledge of all compliance requirements and contract obligations before switching to private practice.

“In terms of hiring a legal and financial adviser, those should be among some of the first things anyone making the transition should do,” he said.

Money matters

The shift to self-employed practice also starts with the decision of whether it will be a traditional fee-for-service or primary direct care example.

Michael Poku, MD, chief clinical officer of Equality Health, a value-based care enabler that works with 3,200 primary care physicians across five states in a value-based care (VBC) environment, notes making a transition from a large hospital system to an independent practice offers physicians a unique opportunity to establish a patient-centric model.

“Independent physicians should not navigate this transition alone,” he says. “They should partner with VBC enablement organizations that offer the necessary infrastructure, data analytics, and administrative and financial support. These partnerships can provide the resources and ongoing investment needed to thrive in a VBC environment.”

While a job in a hospital is usually secure, a private practice can be much more financially lucrative in the long run, Lowe shares, provided there are sufficient finances and business strategies in place.

“It’s important to develop a comprehensive plan for the practice setting with a focus on specific goals, potential earnings, costs, and how long you believe it’ll take for you to be in profit,” he says. “This can be a perplexing endeavor, but working alongside a financial expert who understands health care can make the course of action smoother.”

Lowe also suggests starting small with the intent of assisting a few patients and subsequently broadening this number to aid in growth.

“Independent physicians and organizations such as the American Academy of Private Physicians often help people transition to a financial plan privately,” he says. “Their experienced mentorship is beneficial for those making a switch.”

Legal considerations

Before transitioning to independent practice, it’s also crucial for physicians to familiarize themselves with the legal requirements specific to their state, including licensing, credentialing and insurance requirements.

“Hiring a qualified attorney with expertise in health care law can help navigate the complexities of contract negotiations and compliance with regulations, ensuring a smoother transition into independent practice,” Poku says.

Marketing and growth

When it comes to attracting patients and growing a new practice, word of mouth is invaluable, especially when starting out. It’s essential to establish strong relationships with the patients — taking the time to understand their needs and delivering exceptional care.

“Clinicians can also consider leveraging social media and digital marketing strategies to increase visibility,” DePasquale says. “Referral programs or offering free consultations can also help build an initial patient base. Retention comes down to providing excellent, personalized care and fostering an environment where patients feel heard and valued. I always encourage providers to prioritize patient relationships and maintain open communication channels to ensure they feel connected to your practice.”

What’s more, utilizing a multifaceted marketing strategy can be key to getting the word out. Physicians should harness the power of social media and local community events to boost visibility while implementing loyalty programs and patient engagement initiatives to foster long-lasting relationships and encourage referrals.

After all, creating a strong online presence through patient testimonials and educational content can significantly enhance patient trust and establish the practice as a reputable resource in the community.

“Utilize your connections,” Opris says. “Referrals and previous patients are a great starting point for building your new practice. When you need help with more extensive marketing needs, look for an agency that can help accelerate your marketing efforts.”

Making the decision

For any physician thinking of making a switch, it’s essential to carefully weigh the pros and cons before making the leap, have a clear vision of what they want to achieve, and make sure they are financially and emotionally prepared for the challenges that come with running a business.

“I recommend talking to others who have made the transition and learning from their experiences,” DePasquale says. “Get support from professionals who can help with the business aspects — this is often an area that clinicians overlook but is key to success. Lastly, don’t be afraid to ask for help along the way. It’s okay to rely on experts in areas like accounting, legal advice and marketing to ensure the success of your new practice.”

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Thursday, March 6, 2025

Successfully implementing AI into your medical practice: A strategic and tactical approach

In today’s healthcare landscape, one of the most significant transformations is the implementation of Artificial Intelligence (AI) into healthcare organizations. When change looms on the horizon, having a well-structured strategy is essential—both in terms of big-picture considerations and the tactical steps that will ensure a smooth transition.

While AI adoption has been progressing for several years, there is still substantial ground to cover. A 2024 AMA study found that 38% of doctors currently use AI, primarily for simplifying documentation, care plans, and progress notes. Of those, 43% find AI-driven features beneficial. However, enthusiasm for AI is not universal—a 2024 HIMSS study reports that only 27% of staff members within healthcare organizations view AI positively.

So how can organizations bridge the gap between AI’s potential and its acceptance among providers and staff? The key lies in a dual-pronged approach: strategic planning and tactical execution.

Mapping Your AI Strategy

Electronic Health Records (EHRs) now incorporate a wide range of AI-powered features, but simply enabling these tools does not guarantee success. A thoughtful strategy is necessary to maximize AI’s benefits. Here are three critical components of an AI strategy:

Define your AI vision: Clearly outline your objectives, expected benefits, and the resources required to implement AI effectively. Consider how AI will improve the experience for providers, staff, and patients, and establish measurable goals for success.
Develop a deployment roadmap: Begin by auditing your EHR system to understand which features and workflows are in place. Identify what you are currently utilizing, what you are paying for but not using, and what AI capabilities could replace or enhance. Conduct a cost-benefit analysis for each AI function under consideration.
Assess and adapt workflows: AI will alter how patient visits are conducted and how tasks are performed. Review existing workflows to determine what can support AI adoption, what needs to be modified, and what new processes must be introduced. Documentation, training, and ongoing support for staff and providers will be essential to successful implementation.

Practical considerations for AI implementation

With a strategic foundation in place and refined workflows to support AI rollout, the next step is to
generate awareness and enthusiasm to ensure seamless adoption. We’ve seen healthcare organizations across the U.S. leveraging creative tactics to accomplish this. A few of our favorites are:

Designate an AI champion: Appoint a provider to test and implement AI features in real-time. This approach fosters a sense of ownership and encourages peer advocacy, as firsthand success stories can increase adoption among colleagues.
Start with one use case: Identify one problem you are trying to solve or gain efficiency toward. Map out the current process, who does what, and downstream impact. Then map out the process using the AI tool. Choose the appropriate AI tool/partner. Identify what changes need to be made in current workflows and staff education, along with what type of quality control processes are needed. Finally, define plans to monitor and evaluate performance.
Educate patients with signage: Display informational posters in waiting areas and exam rooms to inform patients about AI usage. In one clinic, signage highlighted the specific AI features in use and reassured patients that AI enhances provider focus during visits.
Provide staff with AI talking points: Equip providers and staff with prepared responses to common patient inquiries about AI. Clear communication builds confidence and helps patients understand how AI benefits their care. Include these talking points within a FAQ sheet available online and in the patient portal.

The future of AI in medical practices

AI presents immense opportunities to enhance clinical and operational efficiency in healthcare organizations. By combining a well-defined strategy with effective engagement tactics, medical practices can foster AI adoption while improving patient care, reducing provider burnout, and streamlining operations. With thoughtful planning and execution, AI can be seamlessly integrated into everyday practice, leading to long-term success for providers, staff, and patients alike.

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Monday, March 3, 2025

Nurse practitioners are key to accessible primary care

Primary care practices that employ nurse practitioners (NPs) are significantly more likely to serve socioeconomically disadvantaged communities, according to a study published February 28 in JAMA Network Open by researchers at Columbia University School of Nursing.

The study, led by Monica O’Reilly-Jacob, PhD, an assistant professor at the university, analyzed 79,743 primary care practices across the United States and found that 53.4% employed NPs in 2023 — more than double the 21% reported in 2012. These practices with NPs were more often located in low-income (23.3% vs. 17.2%) and rural (11.9% vs. 5.5%) areas than those without NPs.

“This study demonstrates that NPs are increasingly utilized for primary care delivery across the country, and especially within low-socioeconomic communities,” O’Reilly-Jacob and her colleagues wrote. “This is important as fewer medical residents are choosing to practice primary care, resulting in an estimated shortfall of 20,200-40,400 primary care physicians by 2036.”

The findings underscore the industry’s growing reliance on NPs to address gaps in primary care availability, particularly in underserved areas, amidst the ongoing primary care shortage. The study found that communities where primary care practices employed NPs had more people living below the poverty level (14.4% vs. 12.8%) and lower levels of education, with more residents lacking high school diplomas (19.8% vs. 18.5%).

Researchers also noted a correlation between economic disadvantage and the presence of NPs. While there may be overall fewer primary care practices in low-income and rural communities, those that do exist are more likely to employ NPs — underscoring the crucial role they play in ensuring access to care for disadvantaged communities.

Policy implications

The study suggests that policymakers should take additional steps to support NPs in disadvantaged areas, “such as strengthening federal and state loan repayment programs, establishing pay parity in state Medicaid programs, and ensuring primary care provider designation for NPs across payers,” the study’s authors wrote, adding, “Such steps would expand the capacity of the primary care system to better meet demand in communities where it is needed most.”

With physician shortages expected to persist, NPs will likely continue playing a critical role in ensuring primary care access for underserved populations.

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Friday, February 21, 2025

Pajama time severance: How to leave work at work

The Apple TV+ series "Severance" follows Mark Scout, a man grieving the loss of his wife outside of the office and who is unaware he has a wife inside the office. The protagonist submits himself to a "severance" procedure, splitting himself into two people. When severed people enter the office, they have no memory of their life outside of work. However, when they are out of office, they have no memory of their 9-5 day.

It is difficult for physicians to leave work at the end of the day and not take it home. We have coined a term for this called pajama time. Pajama time is a term used to describe doctors working outside of regular hours, often at home. Pajama time includes completing EMR records, billing, and creating prior authorizations to obtain permission for patients' medications, tests, or procedures. These pajama-time tasks are uncompensated and may require 1-2 hours of work each evening.

The causes of pajama time include:

Administrative tasks may require doctors to complete these tasks outside of work hours.
Completing electronic health records (EHRs) at the end of the day.
Responding to emails and phone calls that can't done during office hours is done outside of work hours.
Staying current on reading journals and publications cannot be accomplished during work hours; it must be done outside of work hours.

Consequences of pajama time?

Pajama time can affect doctors' job satisfaction and impact patient care.
Pajama time contributes to physician burnout at epidemic proportions, impacting nearly 50% of all physicians.
Deterioration in patient satisfaction impacts our online reputation.
Pajama time can lead to doctors sacrificing personal and family time and deteriorating relationships with family and friends.

To successfully have severance and leave work at work and avoid bringing it home, focus on creating clear boundaries, establishing routines, and practicing self-care techniques.

1. Set clear boundaries:

Define work hours and stick to them, or at least make a commitment that when you leave the office, you will not work at home and will take only emergency calls or emails.
Try to start and end your workday at designated times and resist the urge to check emails or work outside these hours.
Communicate your boundaries: Let your colleagues know you're unavailable after work hours, and avoid taking work-related calls or responding to emails outside your designated work time.

2. Establish routines:

Create a closing ritual: Develop a routine to signal the end of your workday, such as tidying up your workspace, reviewing your to-do list, or planning for the next day.
Use your commute to transition: Utilize your commute time to mentally detach from work and shift your focus to personal activities or relaxation.
Schedule after-work activities: Plan enjoyable activities to look forward to after work, such as exercise, hobbies, or spending time with family and friends.

3. Practice Self-Care:

Prioritize exercise and relaxation: Incorporate physical activity and mindfulness techniques like meditation or yoga to manage stress and improve mental well-being.

4. Limit work-related discussions:Try to avoid work-related conversations at home.

5. Manage your stress:Practice mindfulness:

Engage in mindfulness exercises to help you manage stress, reduce overthinking, and promote mental clarity.
Seek professional support: If you're struggling with work-related stress, consider seeking support from a therapist or life coach.

6. Consider an unplugged hour or, better yet, a day where you do not respond to cell phone\internet. Most of us are tethered to the Internet and iPhone seven days a week and even on vacation. We have become slaves of social media, Email, texting, and apps.

A solution to this enslavement is getting unplugged or having an "electronic" Sabbatical" when you are totally unplugged from the Internet, mobile phone, computer, iPad, and other electronic devices for just a few hours in the evening. After going without the computer umbilical cord in the evening, when you are free from the digital world, you will notice dramatic changes within yourself. You will think differently, act differently, and see things from a new perspective.

Bottom Line: It is not easy to be severed from our work when we go home at the end of the day. However, by implementing a few of these recommendations, you can effectively separate work from personal life, reduce stress, create a healthier work-life balance, and maybe use your pajama time for family and friends and have time to pour yourself a glass of wine and watch an episode of "Severance."

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