By Dr. Reza Mirali / Special to Healthcare Facilities Today

The problems of mounting educational debt compounded with the overwhelmingly high costs of starting and running a practice pose seemingly insurmountable barriers to entry for contemporary physicians in attaining an independent practice.The increasing regulatory burdens of practicing medicine which serve to erode the physician/patient relationship by prioritizing clicks in an EMR to face-to-face interactions, further aggravates the existing barriers and provides the recipe for a generation of physicians who feel as though they’ve lost autonomy and are facing professional burnout at alarming rates. 

As a generally altruistic and socially conscious group, physicians are woefully ill-prepared during their training to address the business of medicine. Thereby leaving a steadily increasing number of newly minted physicians opting for employed models of practice wherein they give up their autonomy in exchange for guaranteed salaries; free from most of the operational burdens of running a practice. Or so they think. In exchange for steady incomes, these clinicians instead must answer to a levels-deep hierarchy of administrators with unrealistic expectations and definitions of what productivity actually means. Data shows that independent physicians tend to earn more than their employed, same-specialty peers. In addition, these physicians have a greater sense of job satisfaction. So, how do we overcome the barriers to independent practice?

The concept of coworking is a fundamental basis of today’s collaborative economy. Shared economy has proven to be a viable solution for all size groups in other professions to keep their operational expenses down and not only to stay viable, but to thrive and expand within the coworking and shared economy. On the first brush, the concept of shared economy is not novel in medicine: physicians have joined groups or formed them for this very reason, but the shared economy had come at a cost of employment, or a larger corporate model that resulted in loss of independence, autonomy or acceptance of a corporate structure that physicians were not familiar with or wanted in the first place.

A medical coworking model, when deployed beyond just a real-estate based medical-office sharing establishment or as a temporary overhead fixes for poorly planned medical practices, allows its member physicians to stay independent and yet benefit from the shared economy.  The benefits of membership in a well-structured physician coworking model are viewed as financial, operational, and professional as well as immediate and long-term benefits. I will break these benefits down by their immediacy and then subdivide further by other categories.

Immediate benefits - These are the benefits that members can realize either immediately as a result of joining a medical coworking model.

Financial benefits-  For physicians looking to start, or to expand, the financial barrier to entry into the practice is in the top three barriers, if not number one. Physicians are looking at $150K->$250K in educational debt and another $75k-$100k in startup cost. The reality remains that they will not generate much revenue in the first year of practice and will need to take out loans to pay their staff, their office expenses and their own personal expenses.  A well-structured comprehensive medical coworking model can take the startup cost to near zero in reference to office buildout, medical supplies and office basic furnishing. Furthermore, due to the existing shared cost structure, the physician member is capable of paying for only the overhead used, and is empowered to scale their practices up or down and thus adjusting their overhead. Additionally, those models that offer solutions for staffing are capable of offering lower cost solutions for the staffing, thus cutting the overhead down in respect to the two highest cost items on overhead: space and staffing.

Operational benefits - As mentioned above, as a general rule, our professional training has done little to prepare us for even the basic steps needed to establish a practice. This step is a well-worn path and there is no need why every physician has to reinvent the wheel in this aspect and carve out a new path. A medical coworking model, if comprehensive enough, provides logistical support to member physicians to advise and guide them in this process. This can be of tremendous value and relief to the graduating residents and even physicians looking to transition from an employed model to independent practice.   

Professional benefits - An incipient and yet veiled outcome of each physician feeling the need to establish physically isolated offices from others have been the isolation of physicians from their colleagues. This model perhaps at one point was seen as necessary or the only option available. The resulting isolation, over the decades of its promulgation, has resulted in poor communication functionally, and misunderstandings amongst or even within specialties. A physician coworking model results in an organically established community of like-minded independent physicians, who interact with each other out of volition and not based on mandatory division/department/corporate rules. The professional desire for growth based on interactions with colleagues can be realized without having to be employed. Additionally, the prominent further benefit is the readily available source of patient referrals, all based on individual relationships built, not based on governance.

Long-term benefits - These are the benefits that members can realize as their practices grow and the membership strengthens.

            Financial benefits - The largest long-term financial benefit of a medical coworking model over the practice life-cycle will be those of practice overhead savings. This will take the form of savings in staffing, staffing benefits, medical supplies, physical space cost, utilities, IT, telephone, waste management, and technologies used in facilitating practice and patient care.  The more comprehensive a coworking model can get the more benefits can be offered to members, such as: expansion to other locations, healthcare and other benefits, office liability, marketing, critical technology acquisition, and vendor contracting. These benefits, in the past, were only realized if physicians were employed or were made to work under one structure.  There is no need why independent physicians can not benefit from these savings as well.

            Operational benefits - A well designed, comprehensive medical coworking model can provide benefits to its members in the daily operations of their practices. The needed administrative skills of running a practice are not those that physicians have been trained to earn nor have they been allowed to exercise and perfect. Thus the needed administrative duties become burdens that will weigh the physicians down and result in profound stress.  This is where the power of well-designed coworking models needs to be complemented by the sharing economy of many to help deliver on a lowered (not non-existent) burden of running a practice- a small business.

            Professional benefits - One of the main characteristics of a coworking model is its ability to allow its members to gain flexibility in their work schedule, thus allowing for a healthier work-life balance. This attribute, in the medical profession, is vital to reduce burnout and increase professional satisfaction and morale. The comprehensive medical coworking model acts as an incubator for those that want to grow and expand. It will also provide flexibility to those that always desired 2-3 days a week schedule but were not given the chance to achieve that.  Ultimately, the physician coworking model allows a realistic means of achieving retirement gradually and on physician’s own terms. 

In summation, and to answer the question raised at the outset, medical coworking model is one of the many innovations needed in helping physicians address the rising challenges of maintaining autonomy and running their practice. It needs to be pointed out that a simple office sharing model or a basic services provision model will not provide the aforementioned benefits.  A properly thought out and comprehensive medical coworking model is integral to realizing the needed benefits sought in today’s healthcare landscape. The impacts of this well-designed model will be ultimately to help re-establish and elevate its physician member morale and professional satisfaction. The indisputable appreciation needs to be that a less stressed and downtrodden physician will provide a recognizably better care of their patients, express higher levels of professional satisfaction and morale and have the reserve and defense mechanism to overcome burnout. This is indeed better for the health of all the patients and the entire society at large.