For example, the staffing concern in rheumatology is a real issue because of a growing population in need of rheumatology care, Dr. Chatwell says. “Younger rheumatologists often have never had any exposure to private practice and the benefits that it can offer. We are the front line of rheumatologic care,” he says. This is one reason he thought it important to participate in the ACR’s new Community Practice Council, made up of rheumatology professionals from small or independent practices, as well as two fellows, and chaired by Tien-I Karleen Su, MD, FACR, who co-founded a practice in California.
Dr. Magnano also sees staffing as major challenge, in addition to inconsistent practice income and navigation of the insurance contracting landscape. “I think that contracting with payers may be the ultimate demise of private practices, simply because private practices lack the leverage of larger, more corporate groups to negotiate evaluation and management reimbursement that keeps pace with inflation,” she says.
She notes that overhead costs have increased 6% to 8% annually since the pandemic, but reimbursement is stagnant or falling. “To continue to provide excellent care, we need to be able to negotiate more lucrative contracts or become more creative in our efficiencies and overhead cost containment,” Dr. Magnano says.
To help address the challenge of overhead costs and running a business, Dr. Daugherty’s practice is a member of American Arthritis and Rheumatology Associates/Bendcare, a group of independent practices that are owners and customers of a rheumatology cooperative. “This organization understands our needs in a way that hospital-based systems do not prioritize and simply don’t understand. We access many services from our supergroup,” he explains.
The Rewards of Community Practice
Despite the challenges of working as private practice rheumatologists, there are also many rewards. Dr. Daugherty even sees a leadership role for private practice rheumatologists in areas such as precision medicine and health care economics because they have more flexibility.
“Having the flexibility to go the extra mile for my patients is the most rewarding aspect of private practice,” Dr. Magnano says. “Because I have the ultimate autonomy in patient care, I have the time and flexibility to make extra calls to patients late at night or circle their other doctors together to develop a thoughtful care plan. I think that patients really value this extra effort and are truly appreciative for my care.”
At Dr. Daugherty’s practice, relationships run so deep with patients that three insurers initially did not offer him a contract because they said they had enough rheumatologists on their panels. After “countless hours” on the phone with patients, they ultimately offered contracts. “It was their advocacy for their healthcare that made these major corporations change their decisions,” he says.
