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Be afraid. Be very afraid. That’s one option for independent primary care physicians – but not one I would advocate if my livelihood were at stake. And make no mistake, community physicians are in danger of becoming extinct in the next decade.

It was recently announced that Village MD will be setting up primary care clinics in Walgreens. Around the same time, Aurora Health announced its intent to take good care of Beaumont physicians – in part by recommending they become employees of the health system. This is not new – but it’s an accelerating trend. These mega health organizations (and private equity groups who see dollar signs but not patients) are courting suitors quickly – as if to get a bargain on a Tiffany ring – while the world reels from a global pandemic. Their typical method of operation historically is to marry into the community full of promises to be good corporate citizens and stewards of care; then, after taking over a health system, spread their web to self-employed physicians, offering them solar systems as yet undiscovered. If you ever want to see an unhappy physician, speak with one who sold their practice to a health system long before they were ready to retire.

While this is a national trend, Michigan physicians are at particular risk because our state led the country in the adoption and advancement of the patient-centered medical home (PCMH) model.  With support from large payors like the Blue Cross and Priority Health, Michigan is viewed as a benchmark state for focusing on primary care and creating multi-disciplinary care teams and other innovative patient-centered approaches that support primary care. Behind this reputation are hundreds of self-employed physician leaders who value their independence and often have quality scores higher than their health system-owned counterparts.  

The market advantage of the for-profit health conglomerates or venture backed primary care firms is capital – gobs of it. Independent physicians can’t compete financially – nor can Physician Organizations. At least not on our own. But together? Now we’re talking.

Why can’t Michigan-based independent primary care physicians partner with their physician organizations (note to physicians – join one now if not already aligned) to serve our local patient populations through clinics in Michigan-based grocery stores and pharmacies? Or in community centers? Or at an employer’s worksite – albeit, with COVID-19 and work from home considerations? Physicians could see patients at their own practices while also serving patients in an external setting – similar to having two office locations. Patients that want to continue the physician/patient relationship beyond the non-traditional setting can choose to see the physician in their office for any follow-up visits. Michigan’s population is aging – which is another reason why outsiders are coming in to serve a growing Medicare Advantage population. Physicians will need to employ aggressive and creative patient recruitment strategies to sustain a financially viable, independent practice  where they maintain ownership, flexibility and control.  If self-employed physicians want to retain their entrepreneurial advantages and get off the endangered species list, now is the time to take action by joining with their fellow independents and creating primary care practice strategies for a rapidly changing landscape.