19-05-2025
Winning Strategies to Retain Private Practice GIs
SAN DIEGO — With the recently updated recommendations by the US Preventive Services Task Force lowering the age for colorectal cancer screening to 45 instead of 50, an additional 19 million patients now require screening, Asma Khapra, MD, a gastroenterologist at Gastro Health in Fairfax, Virginia, told attendees at Digestive Disease Week (DDW) 2025.
That change, coupled with the expected shortage of gastroenterologists, means one thing: The current workforce can't meet patient demand, she said. Private practices in particular face challenges in retaining gastroenterologists, Khapra added.
The private practice model is already declining, she said. The fraction of US gastroenterologists in 'fully independent' private practice was about 30% in 2019, Khapra noted. Then, 'COVID really changed the landscape even more.' By 2022, 'that number has shrunk to 13%.' Meanwhile, 67% are employed gastroenterologists (not in private practice), 7% work in large group practices, and 13% are private equity (PE) backed.
That makes effective retention strategies crucial for private practices, Khapra said. She first addressed the common attractions of private practices, then the challenges, and finally the winning strategies to retain and keep a viable private practice gastroenterology workforce.
The Attractions of Private Practice
The reasons for choosing private practice are many, Khapra said, including:
Autonomy,
Flexibility,
Competitive compensation,
Ownership mindset,
Partnership paths, and
Work-life balance including involvement in community and culture.
On the other hand, private practices have unique challenges, including:
Administrative burdens such as EHR documentation, paperwork, prior authorizations, and staffing issues,
Financial pressures, including competition with the employment packages offered by hospitals, as reimbursements continue to drop and staffing costs increase,
Burnout,
Variety of buy-ins and partnership tracks,
Limited career development, and
The strains of aging and endoscopy. 'We used to joke in our practice that at any given time, three staff members are in physical therapy due to injuries and disabilities.'
Employing the Iceberg Model
One strategy, Khapra said, is to follow Edward T. Hall's Iceberg Model of Culture , which focuses on the importance of both visible and invisible elements.
'The key to retention in private practice is to develop a value system where everyone is treated well and respected and compensated fairly,' she said. 'That doesn't mean you split the pie [equally].'
'Visible' elements of the model include the physical environment, policies and practices, symbols and behaviors, she said. While under the surface ('invisible' elements) are shared values, perceptions and attitudes, leadership style, conflict resolution, decision making and unwritten rules.
The key, she said, is to provide physicians an actual voice in decision making and to avoid favouritism, thus avoiding comments such as 'Why do the same two people always get the prime scoping blocks?'
Financial transparency is also important, Khapra said. And people want flexibility without it being called special treatment. She provided several practical suggestions to accomplish the invisible Iceberg goals.
For instance, she suggested paying for activities outside the practice that physicians do, such as serving on committees. If the practice can't afford that, she suggested asking the affiliated hospitals to do so, noting that such an initiative can often build community support.
Paying more attention to early associates than is typical can also benefit the practice, Khapra said. 'So much effort is made to recruit them, and then once there, we're on to the next [recruits].' Instead, she suggested, 'pay attention to their needs.'
Providing support to physicians who are injured is also crucial and can foster a community culture, she said. For example, one Gastro Health physician was out for 4 weeks due to complications from surgery. 'Everyone jumped in' to help fill the injured physician's shifts, she said, reassuring the physician that the money would be figured out later. 'That's the culture you want to instill.'
To prevent burnout, another key to retaining physicians, 'you have to provide support staff.' And offering good benefits, including parental and maternal leave and disability benefits, is also crucial, Khapra said. Consider practices such as having social dinners, another way to build a sense of community.
Finally, bring in national and local gastroenterologist organizations for discussions, including advocating for fair reimbursement for private practice. Consider working with the Digestive Health Physicians Alliance, which describes itself as the voice of independent gastroenterology, she suggested.
More Perspectives
Jami Kinnucan, MD, a gastroenterologist and associate professor of medicine at Mayo Clinic, Jacksonville , Florida, spoke about optimizing recruitment of young gastroenterologists and provided perspective on Khapra's talk.
'I think there's a lot of overlap' with her topic and retaining private practice gastroenterologists, she said in an interview with Medscape Medical News. Most important, she said, is having an efficient system in which the administrative flow is left to digital tools or other staff, not physicians. 'That will also help to reduce burnout,' she said, and allow physicians to do what they most want to do, which is to focus on providing care to patients.
'People want to feel valued for their work,' she agreed. 'People want opportunity for career development, opportunities for growth.'
As gastroenterologists age, flexibility is important, as it in in general for all physicians, Kinnucan said. She suggested schedule flexibility as one way. For instance, 'if I tell 10 providers, 'I need you to see 100 patients this week, but you can do it however you want,' that promotes flexibility. They might want to see all of them on Monday and Tuesday, for instance. If you give people choice and autonomy, they are more likely to feel like they are part of the decision.'
How do you build a high-functioning team? 'You do it by letting them operate autonomously,' and 'you let people do the things they are really excited about.' And always, as Khapra said, focus on the invisible elements that are so crucial.
