Photo by Paul Flessland
In North Dakota, this relationship is further supported by the state’s unique ownership requirements for private healthcare practices. Essentially, the state requires that healthcare practices are owned by North Dakota-licensed providers. I have been privileged to be the owner of The Facial & Oral Surgery Center (TFAOSC) in Fargo with an outreach clinic in Jamestown, N.D., for nearly nine years. Throughout these years, I have been privileged to have incredible patients, an extraordinarily dedicated and caring staff, and a referral base that is very conscientious and supportive. I am truly grateful that I am part of the healthcare profession as an independent, private-practice surgeon.
There are many benefits to private practice. I retain the flexibility to make quick decisions regarding patient treatment, the purchase of equipment and supplies and directing staff-training to ensure delivery of state-of-the-art care. I am relatively free of the red tape that burdens larger medical practices. Ultimately, I have the luxury to provide the personal attention and time to each
In large practices—such as hospitals—decision-making regarding equipment, personnel, and even procedures can be very slow and often times committee-driven. This can lead to slow adaptation of the latest technologies. In my practice, if I identify a piece of equipment or new procedure that has been well-founded within the medical literature, I can easily adapt to that procedure with adequate training and minimal transitional time. These new procedures often help the patient recover more quickly, with less pain and ultimately with better results.
There are times in the larger institutions that decisions regarding some of these issues are not even made by the healthcare providers but rather administrators or executives within the system. Furthermore, if I identify employee issues that are problematic to the delivery of excellent patient care, I can take quick action to resolve these situations. At larger institutions, there are often layers of bureaucracy that need to be navigated in order to ensure appropriate staff-training or resolution of personnel issues. It is also true that, within a hospital, the physicians are often not able to choose the staff with whom they would prefer to work.
Despite the advantage of independent medical practice, many physicians are seeking to be employed as opposed to owning own their practices. This trend is highlighted by a survey conducted by the Physicians Foundation, which reported that 62 percent of physicians were in independent practices in 2008. However, by 2016, only 33 percent of the surveyed physicians were in independent practices.
There are many reasons for this trend, but two factors seem to be at the center of this alarming decline. The red-tape burdens placed on medical practices are alarming, to say the least.
With the implementation of the Affordable Care Act (ACA), new regulations numbering in the thousands of pages are time-consuming and demoralizing for physicians. What’s more is that, unfortunately, most of these regulations have not been shown to improve patient outcomes or increase the efficiency of the healthcare system. They have, however, resulted in significant increases in the time that doctors spend filling out paperwork and performing administrative functions—as opposed to directly taking care of patients.
There have also been significant changes in reimbursement within the Medicaid and Medicare systems. Unfortunately, these reimbursement schemes significantly favor hospitals over private practices, with the hospitals receiving significantly greater reimbursement for exactly the same procedure that could be done in a private-practice situation.
As hospitals and large group practices can more readily absorb the impact of these changes, it has led many of my physician colleagues to seek employment at hospitals or much larger group practices and abandon private practice. This is unfortunate because the private-practice model seemingly better supports the doctor-patient relationship.
Though there are many challenges within medical practices, North Dakota’s requirement that healthcare practices be owned by the appropriately licensed providers has buoyed the practices of other healthcare practitioners. Dentists, chiropractors, pharmacists and other licensed healthcare providers can thrive in private practice in the state.
Having many smaller practices in these fields improves patient access to care. It also stimulates competition, which helps control prices and encourages innovation. The patients not only win on these accounts, but they are afforded many choices when it comes to selecting their healthcare.
As I strive to provide a compassionate, caring, and competent environment for my patients, I realize the great professional satisfaction gained from owning an independent, private surgical practice. I am both privileged and proud to be part of the healthcare system in North Dakota, which has put the doctor-patient relationship at the center of healthcare, precisely where it belongs.