Challenges for private practice doctors in the Rochester area are prompting some to think about leaving the field.
It’s a move, they say, that could negatively impact the local business community who may see rising employee healthcare costs and limited choices for care as a result.
According to a report from the American Medical Association, the number of physicians working in private practices decreased by 13 percent between 2012 and 2022.
And the numbers continue to fall locally.
“It’s a plight that’s getting worse,” said Lucia Castillejo, CEO of the Monroe County Medical Society.
Challenges for primary care providers range from raising administrative burdens and low and falling payment rates to challenging and costly recruitment efforts and feelings of professional isolation.
Douglas Bennett, MD, has been in private practice at Irondequoit Pediatrics since 2005 and has been a practicing pediatrician for over 25 years.
In addition to the administration challenges, overhead costs and inadequate insurance reimbursements for patient care, Bennett has been dealing with the aftermath of the Change Healthcare cyberattack that prevented his office from filing any claims, impacting his cash flow and hurting the practice.
“It’s the patients who suffer,” he said.
Despite the challenges, Bennett prefers private practice, because it gives him increased freedom and autonomy and a greater focus on patient care.
It can also improve patient care, added Judy Dambrose, office manager at Rochester Community Orthopaedics, noting that private practice providers often have more time to spend with patients because they aren’t pressured to meet certain daily benchmarks.
“In private practice, the biggest goal is to take care of the patient,” Dambrose said.
Private practices can also cost patients less. That’s because they don’t charge as much as physicians affiliated with a large healthcare organization, which have high operating costs that get passed through to patients as hospital or facility fees, she explained.
Further complicating the matter is insurance reimbursement rates the private practitioners say are far from fair and equitable.
The private practice providers — who negotiate reimbursement rates separately — say it has been several years since they have received a substantial increase in those reimbursement rates.
There is also a general misconception as to where the annual increases in health insurance premiums go, Dambrose said.
“They aren’t going to the physicians,” she said.
With all the challenges, a 2023 MCMS Physician Survey found that Rochester area doctors are facing burnout.
The survey — taken by 142 area doctors — found that if no changes are made to the current system, many would consider cutting back hours or leaving primary care entirely.
Monroe County Medical Society Board President Hemant Kalia, MD, said the burnout rates for doctors in the Rochester area are higher than those seen nationally.
Part of the reason for that is the healthcare landscape seen locally, with only two health systems in the region: Rochester Regional Health and UR Medicine, and one insurance payer, Excellus BlueCross BlueShield, that has roughly 80 percent of the market.
Both impact the negotiating ability of private practitioners, Kalia said, and contribute to the multiple stressors on physicians.
“Rochester is a case study in the delivery of health care,” he said, noting that other cities have more choices for insurance, which can increase competitive rates, and more private practice providers who are able to collectively bargain for better rates.
Prior authorization is a big part of the problem, as well, he noted.
Prior authorization — sometimes called preauthorization or precertification — is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
Of the survey respondents, 92.12 percent answered that prior authorization often and sometimes delays access to necessary care which can result in poorer health results, and even death, the survey noted.
Kalia believes it is important to get the word out about the issue in hopes it will decrease the burdens on physicians and make sure patients are getting access to care.
In addition to increasing public awareness, the MCMS is seeking support from area legislators, noting the private practice doctors’ offices not only provide patient care they also serve as a regional economic driver, Kalia said.
“Private practices are small businesses,” he said.
adeckert@bridgetowermedia.com / (585) 653-4021
