The government will not pay you more. Insurers will not pay you more (ex, the pound of flesh we talked about previously). Patients can afford some concierge and direct-pay fees, but do not expect to be able to leverage them, either — they’re also getting squeezed by health care.  

In addition, because of inflation, meaningful use, technology, rental fees, etc, the cost of doing business and compliance will only go up in the next decade.

Primary-care doctors who have been drowning for years understand all of this. I believe that they have one of two options: They can either throw their hands up in the air and join Corp Med for stability (the majority), or they can begin an alternative low-overhead practice (concierge or direct pay).  Mind you, those PCPs who opt for a new model are generally working very lean.


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Non-primary-care doctors trying to enter this space, I believe, have not benefited from the years of being caught under the wheel. They generally opt for high-overhead, personnel-intensive, high-flair practices that truly deliver an awesome product.

But my prediction is that these practices will die an unfortunate and costly death. Because, in the end, no one will pay for it. Medicare won’t pay for it; the insurers may pay for a period of time, but not indefinitely; patients won’t pay for it; and while venture capitalists and tech visionaries may pay in the short term, eventually they won’t like losing money, either.

That’s why I blended a home-based practice and nursing-home work as the two arms of my new business. The common thread, of course, is almost zero overhead. That is where my experience has led me.

Do you want to know if your practice has the right stuff to survive the turbulent future that primary care faces? Ask yourself this question:

How much of every dollar that you make are you paying out to someone else?

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This article originally appeared on Medical Bag