While I was aware of these types of practices for internal medicine and family practice, I was surprised to learn of their existence in the specialty of dermatology. I was able to find concierge dermatologic practices in six medium and large cities around the United States with little difficulty, including even one here in Tucson run by a board-certified dermatologist who operates a mobile service and is willing to “come to your office or home” for an appointment! Suffice it to say, healthcare is being delivered in a very different environment from that of our predecessors. Not only do we have more bureaucratic hoops to jump through, we still must provide the highest quality of care possible in the face of decreasing reimbursement and increasing documentation burdens.
Healthcare delivery in the United States has undergone an amazing change over the past 30-40 years. In the mid-1980s more than 50% of physicians were in independent solo practice. By 2017 that number had fallen to only 36%. Where did all of these physicians go? In 2004, only 11% of physicians were hospital-based; by 2012 that number had risen to 65%, and it has been estimated that by 2019 75% of all newly hired physicians will be hospital employees. Meanwhile, in 1983 only 5% of physicians practiced in groups of 25 or more physicians; by 2014, that number had increased to 20%. This is clear evidence that physicians in independent solo practice are becoming a threatened species. What is responsible for this dramatic shift in how Americans receive their medical care? Young physicians are 2.5 times less likely to be in solo practice than older physicians, and are less likely to replace older physicians as they retire or die. This may be due to the more predictable income and better work-life balance offered by group practices. Younger physicians also generally have less interest in the business aspects