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What are the chief business concerns of independent doctors?

Competing for patients against hospitals and health systems, which have substantial marketing budgets, topped the list of problems independent doctors face, according to a new survey out from the Association of Independent Doctors, a national nonprofit trade association. The pay gap between employed and independent doctors ranked a close second.

“A variety of market forces make it difficult for doctors to stay independent, though most would like to,” said AID executive director Marni Jameson Carey.

AID recently surveyed its members and found that 26 percent of respondents said competing against the hospital for market share was a top concern; 24 percent cited the pay disparity, and 16 percent said receiving inferior treatment due to not being hospital employed.

Because of hospitals’ bargaining power with payers and the fact that hospitals charge facility fees that independent doctors can’t, hospitals can afford to pay salaries to employed doctors that are often greater than independent doctors can earn on their own, said Carey. “We all pay for that in higher premiums.”

Respondents also indicated that the pressure to join a clinically integrated network (12 percent), or to sell their practice to a hospital or private equity group (9 percent) were chief concerns.

However, many of those surveyed are looking to shift toward new practice models that will give them more control of their financial destiny. One third of respondents said they have a concierge practice, a direct-pay practice, or a hybrid practice, where they accept both insured and direct-pay patients. Confirming a tidal shift among U.S. doctors, another 33 percent said that while they don’t currently have a direct-pay or concierge practice, they would like to move in that direction.

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