October 26, 2023
In past decades, most US surgeons completed training and entered private practice. More recently, US surgical practice has shifted to a majority-employee workforce, with most surgeons working for healthcare systems.
In the Town Hall Saving Private Practice, Dmitry Nepomnayshy, MD, FACS, of Lahey Health in Burlington, Massachusetts, and Kevin P. Moriarty, MD, FACS, of UMass Chan Medical School-Baystate in Springfield, Massachusetts, led a debate on this critical shift.
Drs. Moriarty and Nepomnayshy were established in private practice before shifting to employment with healthcare corporations. In an interview, Dr. Nepomnayshy noted that “a vast majority” of colleagues in private practice have made the same shift: “Dr. Moriarty and I were concerned that private practice was dying out.”
The Town Hall opened with Drs. Moriarty and Nepomnayshy sharing their experiences, followed by remarks from two community private practice surgeons: Andrea Resciniti, MD, FACS, of Concord, Massachusetts, and Wassim M. Mazraany, MD, FACS, of Andover, Massachusetts. Collectively, the four surgeons mentioned everything from enhanced research opportunities in employment to the private practice-only option of directly managing one’s own staff members.
Dr. Mazraany focused on offering advice for running a profitable surgical practice. “Solo is not the way to go. It is not survival,” he began, before eventually summarizing, “Run it as a business, don’t run it just as an old mom-and-pop shop, even though it is.”
In an open conversation, additional surgeons—all currently in private practice—shared their perspectives. Echoing the panelists’ remarks, several stated they perceived that private practice allowed them to give higher-quality care with a personal touch, an option lost to surgeons employed in healthcare systems. Similarly, multiple surgeons noted they enjoyed low turnover among their administrative staff, in sharp contrast with the transient teams often found in hospital systems.
However, the Town Hall participants were uniformly frank about the difficulties of maintaining a private practice. Some noted that they were compelled to operate a solo practice for lack of willing partners. Others wondered aloud if they could sustain a career in private practice until retirement.
Several noted that long-term viability was particularly threatened by the shrinking insurance reimbursement rates that had narrowed their margins. Richard J. Harding, MD, FACS, a general surgeon from a private practice of 44 surgeons in Phoenix, Arizona, stated that a recent move to combine practices had been an attempt at capturing “economies of scale” to counteract declining profits.
Due to changing payment models related to managed care, he said, “My RVUs stayed the same, but my income went down by about $100,000.”
While the surgeons did not carry out a planned vote on whether private practice can survive, the reflections of the surgeons in attendance underscored that private practice offers unique challenges and rewards.