Physician Practices
Industry Profile Report
Dive Deep into the industry with a 25+ page industry report (pdf format) including the following chapters
Industry Overview Industry Structure, How Firms Opertate, Industry Trends, Credit Underwriting & Risks, and Industry Forecast.
Call Preparation Quarterly Insight, Call Prep Questions, Industry Terms, and Weblinks.
Financial Insights Working Capital, Capital Financing, Business Valuation, and Financial Benchmarks.
Industry Profile Excerpts
Industry Overview
The 210,600 physician practices in the US consist of primary care and specialty practices. Primary care physicians are responsible for monitoring an individual’s overall medical care, performing physical exams, and treating minor illnesses. Primary care practices include general and family practices, internal medicine, pediatrics, and obstetrics/gynecology. Specialty practices focus on a particular area of medical care and may also perform surgeries to treat problems. Specialists include allergists, cardiologists, dermatologists, gastroenterologists, general surgeons, ophthalmologists, orthopedists, psychiatrists, and radiologists.
Lower Reimbursement Rates
Since only about 9% of patient visits are self-pay, physician practices are highly dependent on reimbursements from private insurance companies, Medicare, and Medicaid.
Hospital Affiliations
The past few years has seen an increase in hospitals purchasing physician practices to grow their revenues and medical staff.
Industry size & Structure
The typical physician practice has a single location, 16 employees, and about $3.2 million in annual revenue.
- There are over 210,600 physician practices in the US with about $504 billion in revenue and over 2.5 million employees.
- There are over 685,800 physicians working in office-based practices.
- Over 883 million patient visits are made annually to physician practices.
- There are two types of physicians - MD (Medical Doctor) and DO (Doctor of Osteopathic Medicine). Both are qualified to perform all types of treatment, including surgery, but DOs emphasize the body's musculoskeletal system, preventive medicine and holistic care.
- Education and training requirements for physicians include 4 years of undergraduate school, 4 years of medical school, and 3 to 8 years of internship and residency. There are 130 accredited medical schools in the US for MD degrees and 37 accredited schools for DO degrees.
- To practice medicine in the US, all physicians must pass either the United States Medical Licensing Exam (USMLE) for MDs or the Comprehensive Osteopathic Medical Licensing Exam (COMLEX) for DOs.
Industry Forecast
Physician Practices Industry Growth
Coronavirus Update
Nov 1, 2021 - Federal Public Health Emergency Extended
- The US Department of Health & Human Services (HHS) has renewed the Public Health Emergency (PHE) declaration for COVID 19 for another 90 days, beginning on October 18 (the date the PHE was previously scheduled to expire) and extending through January 12, 2022. Key regulatory flexibilities and emergency funding sources that are linked to the PHE include but are not limited to 1135 Waivers; Medicare and Medicaid rules regarding Medicare coverage of telehealth, supervision of medical residents, Medicare and Medicaid diagnostic testing, provider-based hospital departments, and the Medicare Shared Savings Program; flexibilities and funding sources established via the Families First Coronavirus Response Act and the CARES Act; and relaxation of certain federal HIPAA privacy and security rules. Clinics should remember that HHS retains the discretion to terminate the PHE at any time.
- Medical experts warn that the approaching flu season could be particularly severe, renewing fears of a potential “twindemic” with COVID-19 still spreading. Health officials are urging the public to get vaccinated against the flu as soon as possible. There may be more unknown factors than ever before, according to Dr. Bill Miller, senior associate dean of research and professor of epidemiology at Ohio State University's College of Public Health. The continuing COVID-19 pandemic is to blame, he added. Many experts say that the flu was essentially squashed during the 2020-21 flu season by masking and social distancing mandated to prevent the spread of the coronavirus.
- A family medicine physician gave the nearly 3,000 patients of her independent practice in South Miami, FL, a deadline of September 15 to get vaccinated against COVID-19 or terminate their in-person patient-physician relationship, according to the Miami Herald. Patients who are unable to find a new physician before the deadline will receive teleconference consultations. "I feel if I can't have a good doctor-patient relationship, I'm not going to be comfortable taking care of those patients, and they should find someone who's a better fit for them," Linda Marraccini, MD, told the Miami Herald.
- Physician practices are still subject to the Center for Disease Control and Prevention’s order requiring masks. The CDC lifted mask requirements in May for most situations if people are vaccinated.
- America’s Physician Groups, an industry association representing physician practices, asked members of the US Congress to increase Future Provider Relief Fund distributions to physician practices struggling with the financial consequences of the COVID-19 pandemic. The Fund, created via the CARES pandemic relief legislation passed in early 2020, includes $178 billion, which the US Department of Health and Human Services (HHS) is to distribute directly to healthcare providers experiencing lost revenues and added costs because of the pandemic.
- Health insurance firms are sending mixed signals regarding payment for telehealth services, according to the nj.com news site. Some are rolling back liberal telehealth reimbursement policies that they launched at the start of the pandemic. UnitedHealth Group, Anthem, Cigna, and CVS Health all have increased some copays and adopted other rules that might cause some patients to delay or avoid telehealth visits unrelated to COVID-19. They also have imposed an array of deadlines, reimbursements and out-of-pocket expenses for telehealth, depending on the insurance plan. Countermeasures may already be under consideration. “Telemedicine has been a huge success. It’s not going away,” said Larry Downs, chief executive of the Medical Society of New Jersey, the state’s largest organization of physicians. “We think that it will be a permanent thing. The discussion and dialogue now is how do we finance it appropriately and ensure people have access.”
- The American College of Physicians (ACP) is asking health insurers to keep COVID-19 flexibilities in effect after the pandemic has passed, and has made several recommendations. The industry advocacy group recommends extending telehealth and telephone flexibilities paid at the same rate as in-person services regardless of platform. ACP also would like direct financial support including reimbursing waived patient cost-sharing responsibilities and direct payment relief payments. The development of more alternative payment models that move away from inconsistent fee-for-service, especially those offering fixed, periodic, prospective payments, has been recommended, and ACP wants health insurers to extend and expand current administrative flexibilities, including broad reprieves from prior authorization requirements, which take time and resources away from patient care.
Get A Demo
Vertical IQ’s Industry Intelligence Platform
See for yourself why nearly 40,000 users trust Vertical IQ for their industry research and call preparation needs. Our easy-to-digest industry insights save call preparation time and help differentiate you from the competition.
Build valuable, lasting relationships by having smarter conversations -
check out Vertical IQ today.