The evolution of practice settings
From the President
Dr. Olbricht served as Academy president from March 2018 to March 2019.
By Suzanne Olbricht, MD, April 2, 2018
In my introductory column as your Academy President, I addressed the many changes facing dermatology and medicine. Over time we have found ourselves adapting to new insurance policies, changes in value-based payments, and increasing federal regulations and compliance programs. Additionally, in just the last several years, there has been a marked change in the settings in which our members practice.
According to the AAD’s 2017 Member Profile Report, 52% of dermatologists now participate in a group setting. The rest of medicine is seeing a similar trend. A Health Affairs study reports that the number of physician/medical groups with nine physicians or less decreased by 5% over a two-year period from 2013 to 2015. At the same time, the number of large groups of 100 physicians or more increased by 6%. The reasons for this change are varied. For some physicians, increased non-clinical administrative work and the emphasis on value-based payment has made functioning as a small or solo practice challenging. Our residents who are often saddled with student debt find that opening a practice or buying a practice may not be a financially feasible option. Many of our members are close to or at retirement age and desire to work less; they are looking for partners who will keep the practice running and also recompense them for their years of investment in the practice. Simultaneously, outside investors are intrigued by the possibility of consolidation of multiple practices yielding financial returns at a time when dermatology could be said to be a growth industry with increased incidence of skin cancer, an aging population, access issues, and a workforce shortage. These investors using private equity or venture capital monies are buying up dermatology practices.
As these changes occur, dermatologists who are currently in solo or small practices may be considering their practice setting and how they operate on a day-to-day basis. Mid-career dermatologists may want to reevaluate the setting in which they practice and determine if change might produce more career satisfaction. Young dermatologists may be looking for information helping them to investigate their various options in order to find a practice setting that would give them a stimulating career beginning. Fortunately, the Academy has remained in tune to the changing environment that has affected health care, and consequently our practices. For physicians who have questions about their next steps, the Academy has developed an online toolkit that breaks down the ins and outs of different practice models. This toolkit offers information for physicians who are thinking of starting or switching practices, adopting a new practice model, or retiring and selling a practice. Each category includes a self-assessment quiz that you can take to see if the path you’re interested in going down is the right one for you, and a multitude of resources to help get you started. I encourage everyone who is considering a change to review the comprehensive information your Academy has developed at staging.aad.org/practicecenter/managing-a-practice/evaluating-practice-models.
Of course, it will be up to every dermatologist to assess their own practice situation, consulting with their legal counsel or business advisor when analyzing practice alignment strategies or business arrangements. However, I hope that the tools and resources the Academy has put together will help guide you in your journey to find the practice setting that works best for you. Changes in health care can be jarring, but rest assured that the Academy has the tools and resources available to help you navigate those changes. As our practices evolve, member needs and Academy activities evolve in order to stay relevant so that we can keep our steadfast commitment to our patients and our profession.
