Is the Future of Solo Medicine the Future of Law?
In reading this article about physicians feeling pressure to join hospital or health network systems, I wondered whether this might be the future for the practice of law as well. The article describes the experience of Dean Pollack, an OBGYN, in practice for thirty years, who is committed to maintain an independent practice – notwithstanding that he competes with well-funded corporate networks, which have the money to advertise on billboards and the leverage to keep him relegated to less prominent listings in physician referral directories.
Although a health network has offered Pollack a significant amount of money to acquire his practice, Pollack declined. According to the article, Pollack wants to practice medicine rather than be an “assembly line physician.” He’s also concerned that network membership is not in the best interest of his patients because the networks rely on lower cost but less experienced new doctors to provide services. In addition, physicians employed by the network are, with limited exceptions (emergency or stated patient preference) obligated to refer all patient services within that system rather than based on the physician’s belief on who is the best quality.
Is this what we want for the practice of law – because that’s exactly what many of the branded networks will deliver. Although current ethics rules theoretically protect against mandatory in-network referrals since clients have an “unfettered” right to the lawyer of their choosing, you can bet that if rules on outside investment are changed, we’ll see a relaxation of other rules as well.
Our profession must think long and hard before going down this path. In the short run, branded platforms might help lawyers, particularly those starting out, find a few clients, albeit at capped or bargain fees. But if we reach the point that the medical profession has – where network services are the only option, clients are in trouble – because our system of justice depends upon the independence of solos.
Of course, the future needn’t be as grim. And in fact, there are plenty of business models also from the medical profession – like concierge services, independent, hyperlocal clinics and techno-powered patient-focused practice – that can make solos sustainable, as well as accessible and affordable to a wider range of clients.
Aren’t the big and mid-size firms the equivalent of the hospital, HMO and PPO networks that doctors are feeling pressured to join? The difference in my mind is that these health care conglomerates are all doing pretty well financially, and the trends seem to be on their side. Indeed, the US government is requiring every citizen to become a customer of health care, and subsidizing the inflated prices (which has the incidental effect of further inflating the prices).
In the legal field, however, the big firms are losing clients right and left. Any client company with competent management brings lawyers in-house as soon as possible, a trend that has been gutting big law for 20 years. The consumption of legal services among the general population is pretty minimal, with many potential customers choosing to go the route of the “uninsured.” And you don’t have the government requiring every citizen to put a lawyer on retainer, or subsidizing my fees so that I could raise my hourly rate to $800. It would be great to have this, but the ABA and other lawyer interest groups suck at lobbying.
I’d say, in your analogy, that the ACA has already happened to the industry following Gideon. The bare fact is that lawyers are not as indispensable as they think they are, whereas doctors are. You can tighten your legal budget, but no one is going to forgo life-extending care no matter how painful, inefficient, or expensive.
But Gideon is a criminal law case. It has no application to the couple that wants to divorce, but cannot afford to each spend $50,000 on lawyers, or the small business that puts together a crappy employment agreement cobbled together from free stuff on the web. And let’s be real — people put off going to the doctor all the time because of the cost, so that when they do eventually get help, it’s much costlier than it would have been had they sought help earlier.
Fair points. I was speaking and thinking too narrowly.
I don’t think that big firms can profit from economies of scale or captive clientele the way that sprawling medical organizations can, so they can’t profit from working with flesh and blood persons.
It’s interesting that incorporated persons need biglaw less than they used to. Do you really think it’s because they are relying more on in-house counsel? Is there no chance that it’s a cyclical trend towards austerity? Anyway, I digress. Thanks for responding.
I think a big part of biglaw’s demise is the shift of work in-house. 25 years ago, going in-house was considered to be less prestigious than going to a law firm. That is certainly no longer the case. And much of the work that law firms used to do for corporate clients is now done in-house — not just drafting contracts, securities work, and corporate governance, but employment law, and even some litigation. What’s left for the big law firms is arcane areas of law, extremely complex areas (huge mergers, but not ordinary acquisitions), and bet-the-company litigation. Any company of decent size will have at least one in-house lawyer, and companies like Google have hundreds.
So now there is a segment that is perhaps too small to justify hiring in-house, but they still can’t afford to pay $350 to $800 an hour for a lawyer. They need lower rates, flexible billing arrangements, etc., but they aren’t going to get it from big law. That means that they are instead just shouldering the risk of doing something wrong, or they are desperately searching for, I hope, solos and smalls that can meet their needs.
Carolyn – To which “branded networks” do you refer? I would love to write about what ones exist, and what success they are/aren’t seeing today… Sounds like a fun and fascinating project.