The Demise of Small and Solo Practice

What does the future hold for small and solo GP and specialist practices in Canada? Are solo practices slowly moving towards extinction or is there a future for this traditional form of care? Programs designed to bring together primary care practitioners in groups through primary care care networks have been developed in multiple Canadian provinces, supported by a technology infrastructure. In many cases, the EMR has been the glue that has allowed for cost and resource sharing amongst practices while still maintaining the independence of one’s own office. The networks, in combination with provincial funding support to adopt an Electronic Medical Record have allowed GPs as well as some specialists to maintain their solo practices for the near term. However, the shift towards accountable and measureable care as well as cost pressures on health systems that are being filtered down to doctors is making it more difficult to sustain a practice without the ability to pass on the increasing overhead as well as maintain increasingly stringent reporting requirements.

Although the U.S. healthcare system is structured differently, perhaps we should take a look south of the border to see what is happening in small practices, as there may be some indication of what we could expect to see in Canada. In an article in TechTarget, titled, “Small practices, solo docs air EHR implementation, meaningful use woes” at a recent U.S. House of Representatives Subcommittee on Investigations, Oversight and Regulations’ hearing, the message came through loud and clear.

“If declining reimbursements don’t kill them, electronic health record (EHR) implementation and meaningful use compliance will finish the job.”

Small and solo practices are under great pressure due to increased regulation, declining Medicare reimbursement, and increasingly more stringent reporting requirements. Add to this penalty programs associated with adoption of ePrescribing and EMR (initially supported by incentives) and the need to make the upfront investment before being able to claim the incentives and practices are struggling to survive. This is not just in primary care — typically more well-off specialties, such as cardiology, are having a similar challenge. The result of all of these factors is a trend towards joining larger groups or hospitals that have additional resources to manage reimbursement, reporting, and compliance.

What has been astounding in the U.S. is the speed with which these national programs are being applied. EMR adoption is growing rapidly and certain specialties (such as family practice) are reporting that over 65% of their members have now adopted EMRs. The next phase is optimizing the EMR to work more effectively.

Provinces are evaluating the application of Meaningful Use measures in order to track and report on patients with Chronic Disease as well as preventive care measures. Although the Accountable Care Organization (ACO) structure does not exist in the same format in Canada, we are moving towards care that can be tracked and measured as governments strive to extract value from scarce healthcare funds.

What has been your experience? Are you in solo or a small physician practice? Do you believe your practice structure is sustainable? Share your thoughts by clicking on the “Comments” link below.

Comments

[Dr Michael Golbey]

I do believe that my current, traditional family practice type is completely sustainable - and this is significantly aided by the introduction of my EMR for all sorts of reasons. However, as I try to find someone to take over my practice when I retire this year, it is becoming clear to me that most new FPs do not want to consider this type of practice, and have no interest in the current, "small business" model of family practice.