Solo Practice Challenges
Today’s realities present a number of challenges to independent practitioners. These range from declining reimbursements and shrinking insurance provider networks to increased regulatory requirements and competition for a shrinking patient base.
The impact of the Affordable Care Act has also been significant. The increase in regulatory requirements is especially onerous for solo and small practices, which frequently lack the access to capital necessary to implement electronic medical record systems, meet mandatory quality reporting, and make the transition to ICD-10. Escalating overhead costs, particularly for medical liability insurance and staff salaries, and the difficulty in recruiting new surgeons to the practice are other challenges.
Members were asked to identify their practice setting. In 2014, the most popular practice setting was a group private practice (35 percent), followed by academic practice (16 percent), solo private practice (15 percent), hospital (15 percent) and multispecialty group private practice (10 percent). Locum Tenens, military, HMO, public institution, and other accounted for the remaining 9 percent. The results showed that orthopaedic surgeons were leaving solo and group private practice settings and moving to hospital centers and academic practice.
Overall, the traditional orthopaedic private practice setting has decreased from 65.2 percent in 2008 to 50 percent in 2014. At the same time, hospital employment has increased from 6.7 percent to 15 percent. It is unclear whether this trend of hospital employment will continue to increase. As employed orthopedic surgeons renegotiate their initial employment agreements, some attrition may occur. The salaried academic practice setting has also increased significantly—from 12 percent in 2008 to 16 percent in 2014.
Orthopaedic surgeons of all ages can be found in all practice settings. Hospitals/medical centers equally employ orthopaedists from all age groups until age 70. Multispecialty orthopaedic groups tend to hire those aged between 30 and 69 years. Older orthopaedists can be found in solo practices, while most orthopaedists younger than age 50 work in private orthopaedic groups.