Do you scratch it or give it an upper-class nod to the French origin of the word?? Do you say ‘nitch’ or ‘neesh?’ Do you judge me if I use the more plebeian pronunciation?
I only ask because it seems the path forward for independent physicians is increasingly bifurcating into one of two fundamental strategies. You can build your practice into a ‘platform,’ something we’ll explore more in coming posts, or you can pursue one of several niche alternatives, however you wish to pronounce it.
Now, the niche road may, at first glance, just seem like a fancier way to describe a solo or small practice, especially if you say ‘neesh,’ but I want to press into that a little more to get at some emerging differences.
Small practices, as we’ve known them in the past, are getting harder and harder to sustain. If you are a garden-variety solo physician, making a living off your pro fee claims submitted to third party government and commercial payers, it has been getting tougher for years now, so this is not news.
There are obstacles at every turn. Managed care contracts are ‘take it or leave it’ deals as reimbursement rates continue to slide. MIPS and MACRA either increase costs or further nibble at payment rates. Technology is complex and expensive. New compliance issue sprout like dandelions in the spring. And employees…well, humans are messy, aren’t they?
On the positive side, there are more options than ever before for physicians who want to pursue the niche strategy. Concierge medicine and a seemingly endless stream of cash-based physician services are just one type of this alternative. Others carve a distinctive clinical focus that sets them apart, again often with a cash-pay service line that supplements the traditional fee-for-service model.
Also, a plethora of contractor gigs are now available, from time covering a telemedicine shift to time in the urgent care. Some physicians now make their nut by getting on a plane to somewhere in rural America twice a month for a long weekend, not for a camping trip, but instead to cover the ER on a locum’s assignment.
The point is for many physicians, the path to independence is increasingly personal. They find a niche that works for their skills and life objectives. They customize and configure their professional career more as a solitary professional than a medical practice.
This model works and comes with many advantages. But if you go this route, save aggressively and invest smartly for there is likely nothing to sell at the end of the run. When you’re done, you’re done.
Alternatively, if you want to build and be part of a medical group the stakes also keep getting higher. Even that may not be enough. Now, instead of ‘practice’ you want to think ‘platform.’ There are many versions of this model as well and we’ll start exploring those.
At least how to pronounce ‘platform’ is clear.