- 66% have or aspire to direct-pay or concierge practices

(Winter Park, Fla.) - Competing for patients against hospitals and health systems, which have substantial marketing budgets, topped the list of pressing problems independent doctors face, according to a new survey out from the Association of Independent Doctors, a national nonprofit trade association. The pay disparity between employed and independent doctors ranked a close second.

"Independent doctors regularly report that staying independent is difficult due to a variety of market forces," said AID executive director Marni Jameson Carey. To uncover which pressures were of greatest concern, AID surveyed its members. Among those who responded, 26 percent said competing against the hospital for market share was their top concern; 24 percent cited the pay disparity, and 16 percent said receiving inferior treatment due to not being hospital employed was a problem.

Because of hospitals' bargaining power with payers and the fact that hospitals can charge facility fees that independent doctors can't, hospitals can afford to pay salaries to employed doctors that are often greater than independent doctors can earn on their own, said Carey. "We all pay for that in higher premiums and taxes."

Respondents also indicated that the pressure to join a clinically integrated network (12 percent), or to sell their practice to a hospital or private equity group (9 percent) were concerns.

However, many of those surveyed are looking to shift toward new practice models that will give them more control of their financial destiny. One third of respondents said they currently have a concierge practice, a direct-pay practice, or a hybrid practice, where they accept both insured and direct-pay patients. Confirming a tidal shift among U.S. doctors, another 33 percent said that while they don't currently have a direct-pay or concierge practice, they would like to move in that direction.

In a separate survey of AID's dentist members, four out of five said they would like to move to a straight fee-for-service only practice and opt out of all insurance plans, including Medicare and Medicaid.

With members in 35 states, AID works to support independent doctors, while educating consumers, businesses and lawmakers about why the survival of independent doctors is crucial to keeping health-care costs down and to eliminating doctor burnout. Researchers at the NYU School of Medicine found that among doctors in small independent practices, only 13.5 percent suffered burnout compared to a national average of 54.4 percent.

Of the 1,022 members AID surveyed, 62 responded (6 percent). Of the 21 dental members surveyed, 10 responded (50 percent).

When asked how AID could best help independent doctors, half of respondents said by informing consumers about the importance of choosing an independent doctor, while 40 percent said by working with lawmakers to create policies that support independent doctors.