“There is nothing wrong with change, if it is in the right direction.”

These words by Winston Churchill describe how physicians and health care systems view the changing health care environment in Lancaster County.

Like communities nationwide, a majority of county family medicine physicians have left private practice for employment with hospital-owned health care systems. This trend supports the American Medical Association’s survey citing a national decline in physician-owned practices.

“The health care environment has become increasingly challenging for family physician practices to remain independent,” says Beth Gerber, executive director of Lancaster City and County Medical Society.

Physicians and patients both benefit from a larger system, says Dr. William Bird, Penn State Health Medical Group senior vice president.

“Our primary care physicians become partners with a larger group of health professionals who provide integration of care close to home for patients,” Bird says.

Small practices, he says, no longer need to struggle with the complexity of rising overhead and decreasing third-party insurance reimbursement. He says Penn State supports private practitioners and offers help to deliver great care.

Dr. Richard Frey, Penn State Medical Group-South Lancaster, was an independent family physician for 19 years. He joined Physicians’ Alliance Ltd. in 2004, and believes the acquisition by Penn State Health is “a good fit.”

“Medicine is evolving with an emphasis on keeping people healthy. Doctors need financial, operational and technological resources available from a larger system,” he says.

Dr. Karen Jones, senior vice president of WellSpan Health and president of WellSpan Medical Group, describes independent family physicians as “partners in the community.” She says some are good at navigating administrative, IT and regulatory requirements.

But those tasks are one reason doctors leave private practice, she says.

“Physicians are often interested in offloading administrative tasks to focus on practicing medicine and caring for patients, not running their own business,” Jones says. “WellSpan doctors have the advantage to connect with colleagues in a coordinated physician care-team network.”

Time to practice medicine without the worry of “ever-increasing regulations and paperwork,” along with access to myriad resources, drew Dr. Christopher Brabazon to WellSpan Medical Group.

“As part of a health system, it’s easier to coordinate patient care by sharing electronic medical records with specialists who are part of the care team,” says Brabazon, of WellSpan Family Medicine in Ephrata.

Dr. John Wood, medical director of Lancaster General Physicians, agrees that electronic consultation between team-based care health professionals available through larger health systems leads to increased care and decreased costs.

“Smarter spending through pooled resources,” says Wood, draws independent family practitioners to join Lancaster General Health/Penn Medicine.

After 16 years in private practice, Dr. Michael Shirk, who has locations on Manor Ridge Drive and North Duke Street, became an LG Health Family Medicine practice. Being part of a health system led to better, faster electronic medical records and quicker access to care for patients,

he says.

“LG Health’s relationship with Penn Medicine results in better health care at a lower cost,” Shirk says.

Physicians in a health care system gain access to support for tasks difficult to manage in an individual practice setting, says Philip Guarneschelli, president and CEO of UPMC Pinnacle. UPMC will continue to partner with independent practices in physician-led quality programs, he says.

“The shift to value-based care to build healthier

populations makes it more important to strive for

enhanced quality and

greater value for patients, providers, payers and communities,” he says.

Dr. Mark Gottlieb, UPMC Pinnacle medical director, Lancaster Region, said a huge benefit of a health system is the high quality of clinical providers it attracts from all specialties. “At the end of the day, patients benefit from the depth, diversity and integration of our system,” he says.

Staying private

As an independent family practice, Stephen Diamantoni, M.D. and

Associates remains committed to provide optimal patient-centered care.

Diamantoni, also Lancaster County coroner, acknowledges health care costs are a challenge for his five county family practice locations. But he’s confident the practice can sustain falling revenues by creating new ones. Investments in technology and infrastructure have already confirmed it.

“Our independence historically has allowed us to control options of health care delivery in a way we feel best benefits our patients,” Diamantoni says.

Dr. Vu Nguyen of Akron feels no pressure as a private practitioner to be employed by a larger health system. The sole practitioner

realizes being independent gives him less bargaining power, but isn’t convinced bigger is better, especially for his patients.

“The systems and insurance companies are getting bigger, giving them more influence and power. Unfortunately patients and physicians can get lost in the shuffle,” Nguyen says.

His hope is that patients will be attracted to the independent physician model.

“My goal is to grow my practice and not be a medical mill to crank out patient numbers,” he says.¶