Doctors of South Carolina joining Doctors of South Carolina joining together to preserve, promote, and together to preserve, promote, and protect the independent practice of protect the independent practice of medicine to ensure that patients in medicine to ensure that patients in South Carolina have alternatives and South Carolina have alternatives and access to high quality, doctor-driven access to high quality, doctor-driven care. care.
Dr. Marcelo Hochman
South Carolina’s independent physician practices number approximately 2000, a shrinking number mirroring the national trend. There are numerous reasons for this, mostly attributable to financial pressures and burdensome bureaucratic requirements. The exit route for many doctors has been to hospital employment.
As hospital systems expand and consolidate, however, it creates significant concentration risk and
threatening continuity if a major system falters. The employed workforce would, of course, be directly affected in this case. This consolidation has led to two conglomerates controlling about 65% of staffed hospital beds in the state, creating significant risk: if either system faces financial or operational trouble, care disruptions could be widespread.
Independent practices serve as a crucial counterweight, providing geographic and ownership diversification, curbing healthcare costs, and reducing public financial exposure. Peer-reviewed studies show independent competition keeps commercial rates 15-40% lower than in monopoly markets. Their distributed operations also allow for faster recovery after crises like pandemics or cyberattacks.
Unlike hospital systems reliant on taxpayer-backed bonds, independent clinics are privately financed, reducing public financial exposure. The two largest healthcare
systems in South Carolina hold a combined debt of greater than $3 billion –much of which is guaranteed by the State’s credit rating and predicated on successful expansion.
Recent reforms reinforce the importance of a robust independent sector. The repeal of South Carolina’s certificate of need (CON) law removed major barriers to entry for new providers, unleashing market competition and enabling independent practices to expand, innovate, and reach underserved areas more easily. Doctors and the private financial market need to take advantage of this opportunity.
Micro-hospitals, hernia repair centers, birthing centers, and a myriad of other interventional facilities are needed. Membership based pediatric practices, Telehealth-heavy mental health practices – the possibilities for innovation are endless. This free-market approach is further strengthened by elimination of physician non-compete agreements, which would enhance physician mobility, support new practice formation, and improve patient access—especially in rural communities. Bill S.46 legislating this will be moved on once the legislative session reconvenes.
Tax incentives for charity care, another bill in the pipeline, would encourage independent physicians to provide uncompensated care, shifting the burden away from the public sector and reducing reliance on taxpayer-funded hospital bailouts. Joining IndeDocs—the state’s leading organization dedicated to independent medicine—empowers physicians with advocacy, pooled resources, and a unified voice to protect autonomy and patient choice, ensuring the independent sector remains a resilient “circuit breaker” against hospital overconsolidation and its attendant risks.
Independent medicine allows you to create the practice environment you want and allows you to provide the type of care that you would want as a patient. IndeDocs is the organization that can help bolster your existing practice or help you launch a new one.
Join us.
Dr. Marcelo Hochman IndeDocs President
Fall is just around the corner. As the leaves begin to turn and temperatures drop, independent medical practices face a host of seasonal shifts: an uptick in respiratory illnesses, changes in patient scheduling, and the ever‐present pressure of regulatory and financial obligations. With thoughtful planning and targeted strategies, practices can not only navigate but thrive during the autumn months. On the following pages, we outline key autumn health strategies for independent practices, focusing on clinical operations, staffing, revenue cycle management, compliance, and patient engagement.
Dedicated “Vaccine Hours”: Reserve specific times each week for flu and RSV shots to prevent overcrowding regular appointment slots.
Stock Forecasting: Review last autumn’s vaccine usage and place orders by late summer to avoid shortages or price hikes.
Clear Triage Protocols: Provide staff with symptom-based algorithms (e.g., fever + cough → same-day sick appointment) to quickly identify contagious patients.
Telehealth Triage: Offer brief virtual visits for mild respiratory symptoms to free up in-office capacity.
Wellness + Vaccine Visits: Encourage patients to schedule routine or chronic‐care appointments alongside their vaccines to maximize efficiency.
Back-to-School Outreach: Remind families about required sports physicals and immunizations, offering “back-to-school health bundles” (physical + vaccines).
Flexible Scheduling: Survey staff in August about school-year commitments so you can arrange cross-coverage or temporary help.
Cross-Training: Ensure multiple team members can handle scheduling, insurance verification, and basic triage to avoid bottlenecks when someone is out.
Pre-visit Forms: Have patients complete online questionnaires 24 hours before appointments, reducing in-office paperwork.
Dedicated Chart-Closure Time: Block two short weekly sessions for providers to finalize charts promptly, preventing EHR backlogs.
“Early Fall Procedure” Campaign: Highlight to patients that scheduling elective procedures in September uses remaining deductibles before they reset.
“Preauthorization Tracking: Assign someone to monitor insurers’ October benefit-year changes and renew expiring preauthorizations before the reset.
Bulk Purchasing: Order high-use supplies—vaccines, rapid tests, PPE—in late summer to secure better pricing.
Cash-Flow Forecasting: Use last year’s autumn revenue and expenses to pinpoint and address potential cash shortfalls (e.g., mid-September vaccine costs).
October 1 Deadline: Track staff flu-vaccine status in a simple spreadsheet; offer an on-site clinic in mid-September to facilitate compliance.
Master Calendar: List all clinician recredentialing dates, payer contract expirations, and reporting deadlines (e.g., Q3 quality submissions). Review monthly to avoid last-minute scrambles.
Outsource if Needed: If internal resources are tight, consider a credentialing service to handle renewals and payer negotiations.
Segmented Messaging: Instead of a broad “Flu Shots Available” blast, tailor reminders: e.g., “Pediatric Fall Check + Flu Shot” for families, and “Protect Your Heart: Schedule Your Flu Vaccine” for chronic-disease patients.
Emphasize Convenience: Highlight bundled services—“Get Your Annual Exam and Flu Shot in One Visit”—in emails, texts, and social posts.
Staggered Communications:
Early August: Back-to-school reminders
Late August/Early September: Vaccine availability
Mid-September: Chronic-care check-ins
Early October: Elective procedure reminders
Multi-Channel Approach: Use brief text alerts (“Flu shots are here—book now: [link]”) alongside email and social media to reach more patients without overwhelming any single channel.
Autumn’s seasonal pressures—vaccine demand, school-year scheduling, deductible resets, and compliance deadlines—can strain independent practices. By forecasting needs, streamlining workflows, and crafting targeted communications, practices can transform challenges into opportunities for patient-centered care and operational resilience.
Robert M. Sade, MD, is Distinguished University Professor of Surgery at the Medical University of South Carolina, where he directs both the Institute of Human Values in Health Care and the Clinical Research Ethics Program. A Harvard-trained pediatric cardiac surgeon, Dr. Sade founded MUSC’s Section of Pediatric Cardiac Surgery in 1975 and has since become a national leader in biomedical ethics.
He has authored hundreds of publications on surgery, ethics, and health policy, and chaired multiple national ethics committees. He currently chairs the Cardiothoracic Ethics Forum and serves as Associate Editor of the Annals of Thoracic Surgery.
We are deeply grateful to Dr. Robert Sade for sharing his expertise and perspective on bioethics for this issue of IndeDocs. His thoughtful insights into the ethical challenges faced by independent physicians provide valuable context for navigating complex decisions without the backing of large institutions. Dr. Sade’s contributions enrich our understanding of how core ethical principles can guide practice in today’s shifting healthcare landscape.
by Dr. Robert M. Sade
In an era of increasing specialization and complex health systems, solo and small-group practices remain a critical part of patient care across the United States. These independent clinicians often navigate ethical challenges without the institutional scaffolding of hospital-based ethics committees. Yet, the four foundational bioethical principles articulated by Tom Beauchamp and James Childress autonomy, beneficence, non-maleficence, and justice continue to offer robust guidance, even in the absence of formalized support structures.
In independent settings, respecting patient autonomy begins with robust informed consent. Physicians must ensure patients understand treatment options, risks, and alternatives in language tailored to their level of comprehension. Even when a physician disagrees with a patient’s decision, honoring that choice affirms the principle that patients are the ultimate decisionmakers in their own care.
Beneficence is often expressed in the unglamorous but essential acts of advocacy: coordinating referrals, educating patients about complex conditions, or helping them navigate insurance and cost barriers. Conversely, nonmaleficence requires careful consideration of harms, especially in resourcelimited settings. A solo practitioner may, for example, forgo an aggressive but uncertain treatment plan in favor of a safer, more manageable option that aligns with the patient’s goals and context.
The principle of justice plays out subtly but significantly in daily practice. In smaller offices, justice may mean ensuring fair allocation of appointment slots, equitably distributing free medication samples, or guarding against unconscious bias in referring patients for specialty care.
In the absence of institutional guidance, the AMA Code of Medical Ethics remains a valuable resource. As a living document, updated biennially by the Council on Ethical and Judicial Affairs (CEJA), it provides practical, physicianfocused advice. Having served on and chaired CEJA, I can attest to the Code’s value in helping independent practitioners navigate dilemmas both expected and unforeseen.
During my tenure founding and chairing the Cardiothoracic Ethics Forum—a 30member body that over 25 years generated hundreds of peer-reviewed publications and national conference sessions—I observed that the ethical questions most commonly associated with hospital care are increasingly relevant in the outpatient setting.
For instance, advance care planning should begin not in the intensive care unit, but in the outpatient office. Primary and specialty physicians can help patients articulate their wishes through durable powers of attorney and living wills, long before a crisis strips them of decision-making capacity. Similarly, shared decision-making is not a luxury reserved for academic centers but a daily necessity. Moving away from paternalism, independent practitioners must incorporate patients’ values as co-equal to clinical data.
Moreover, outpatient practices face ethical dilemmas that extend beyond clinical decisions. Questions of professionalism arise in interactions with pharmaceutical and device representatives, the use of social media, and participation in charitable or community activities. Even office staff conduct can raise ethical issues: patient complaints to state medical boards frequently stem from poor front-desk experiences. This underscores the value of embedding ethics and etiquette training into regular staff meetings.
Informed consent remains a cornerstone of ethical care but poses logistical challenges in independent practice. Strategies to ensure quality without adding undue burden include initiating discussions well in advance of key decisions, spreading conversations across multiple visits, and using plain language instead of medical jargon.
Written summaries or multimedia tools can aid patient understanding without monopolizing physician time. Graphical explanations, in particular, have proven useful in communicating complex options. Another highly effective tool is the teach-back method, where patients are invited to explain information in their own words. This not only verifies comprehension but also serves as a form of legal documentation.
Even small practices benefit from a clear and actionable ethical framework. Drafting a concise document outlining expectations for professional conduct, patient confidentiality, conflict resolution, and clinical decision-making protocols is a practical starting point. Thanks to AI tools like ChatGPT or Gemini, creating such a document is more accessible than ever.
Once established, the policy can be revisited during staff workshops or meetings using real case studies. Fostering a culture where staff feel comfortable raising concerns is crucial. Anonymous reporting mechanisms can also support accountability. Importantly, physicians and senior staff must model ethical behavior consistently.
Physicians in small communities often face dual relationships, caring for friends, neighbors, or even local colleagues. These situations require heightened sensitivity to professional boundaries. Whenever there is a potential for compromised objectivity, referring the patient to another clinician is the safest course. It bears repeating that physicians should avoid treating their own family members except in emergencies.
In these contexts, strict adherence to patient confidentiality is essential. Casual conversations in social settings can unintentionally breach privacy. A written policy on treating close acquaintances, again easily created with AI assistance, can provide clarity for all staff.
Independent physicians frequently care for patients with diverse cultural or religious values. A Jehovah’s Witness declining transfusion, or a patient refusing a recommended procedure for faith-based reasons, presents an ethical challenge. Rather than imposing clinical preferences, practitioners must strive to understand and respect patients’ worldviews, offering evidence-based alternatives when possible.
Shared decision-making, rooted in mutual respect and transparent communication, empowers patients to make choices that align with their values. While beneficence may push clinicians to recommend what they believe is best, true ethical practice respects a competent adult’s right to decline.
Perhaps the most sensitive situations arise when patients disclose thoughts of self-harm or intent to harm others. Without a hospital system’s legal and psychiatric infrastructure, independent physicians must rely on local mental health professionals, crisis services, and their own clinical judgment.
Assessing the immediacy of risk through direct questioning is essential. Physicians must be familiar with state-specific laws regarding mandatory reporting, especially for imminent threats or vulnerable populations. While confidentiality is sacred in medicine, it does not outweigh the duty to protect life when danger is clear and present.
In these cases, relationships with legal counsel or mental health advisors— even informal ones—can provide indispensable support. Clear, contemporaneous documentation of assessments and actions taken serves to protect both patients and physicians alike.
Independent medical practice offers autonomy and flexibility but also demands a strong ethical compass. By grounding daily decision-making in the four bioethical principles—and supplementing them with practical tools, staff training, and resources like the AMA Code of Medical Ethics—solo and smallgroup practitioners can confidently navigate ethical complexity without institutional infrastructure. In the end, what guides these physicians is the same as what guides all good medicine: respect for your patients, commitment to doing the right thing, diligence in avoiding harm, and an unwavering sense of fairness.
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In recent years, the independent medical community has observed a clear shift: patients arrive at appointments armed with insights gleaned from AI chatbots, TikTok videos, TED Talks, podcasts, and popular health books. What was once a novelty is now commonplace—over 60% of patients under 50 consult online forums, social media, or AI tools before seeking medical advice*. While this trend empowers individuals to take ownership of their health, it also challenges independent practices to integrate patients’ self-sourced knowledge into medical visits without sacrificing quality of care.
Acknowledging patients’ efforts to stay informed and gently guiding them toward reliable, evidence‑based resources is essential.
While concerns surrounding misinformation are of course wellfounded, it’s important to recognize that when patients come to the office with articles, videos, or AIgenerated summaries in hand, they’re often reacting to more than just curiosity; they’re responding to feelings of confusion and fear stemming from a landscape of conflicting messages, past experiences of feeling dismissed, or genuine concern that their symptoms won’t be taken seriously. Many have heard stories of serious conditions overlooked or misdiagnosed, so gathering information becomes a way to protect themselves against being unheard. In that sense, their research is not merely an academic exercise but an emotionally-driven attempt to assert agency over their own health.
By acknowledging that these patients have already taken a meaningful first step—that they care deeply about their well-being and are eager to participate in decision-making—independent physicians can channel this proactive engagement into a collaborative visit. Framing the encounter as a partnership allows both doctor and patient to address underlying concerns, validate each other’s perspectives, and jointly navigate toward evidence-based recommendations that align with the patient’s values and fears.
Practice‐wide awareness is important for managing patients who arrive with extensive research. By training front‐desk staff and medical assistants to watch for signals—like screenshots or links uploaded via the portal or a checked “research disclosure” box—practices can flag these cases early and offer slightly extended “complex” appointments so physicians have sufficient time without derailing the schedule. In particularly detailed situations—when patients bring lengthy AI reports or multiple videos—brief Telehealth follow‐ups can resolve lingering questions without pulling in‐office slots off track.
Simultaneously, team‐based collaboration streamlines care: allied staff can spend extra minutes during intake gathering context on a patient’s sources and noting any red flags, while chart templates include a “Patient’s External Sources” section so providers see at a glance what materials were consulted. By combining these steps with a tiered appointment system—using standard slots for routine visits and longer slots for research‐heavy consultations—practices honor patient engagement while maintaining overall efficiency.
Equipping patients with a concise, up-to-date repository of trusted resources helps practices respond quickly and compassionately. Rather than debating each individual claim in real time, clinical teams can refer patients to a curated list of reputable medical societies, peer-reviewed journals, and evidencebased patient-education platforms—hosted on the practice website or provided as a one-page handout. When a patient mentions a questionable TikTok claim or AI recommendation, the physician can direct them to these vetted sources, reinforcing accurate information without prolonging the visit.
A doctor's fiduciary responsibility to their patients is to provide the best information they can and guide them to make their own informed choices. Fostering a culture of empathy, humility, and shared decision‑making is essential. When patients arrive with their own research, it opens a dialogue where both physician and patient can learn from one another and make informed care choices together. Acknowledging patients’ efforts to stay informed and gently guiding them toward reliable, evidence‑based resources helps reinforce adherence to treatment plans and keeps patients actively engaged in their health journey.
In today’s healthcare landscape, where wellinformed, engaged patients are increasingly common, practices that blend compassion with expertise will flourish.
The IndeDocs Board of Directors are passionate advocates for independent medicine and have dedicated their careers to upholding the doctor-patient relationship as the most important tenet of medicine.
DR.MARCELOHOCHMAN PRESIDENT
DR. DANIEL ROSNER TREASURER
DR. JAMES DICKSON
DR. EVELINE “DEDE” WARING VICE PRESIDENT
DR. MIKE FINCH SECRETARY
DR. DANIEL BALOG
DR. OSCAR LOVELACE FOUNDER OF INDEDOCS
DR. MORRIS BROWN
DR. JULIETTE WALKER
Learn more about the IndeDocs Board of Directors and how they support the autonomy and patient-centric approach of independent practice:
www.IndeDocs.com/about-us
IndeDocs, a proud 501(c)(6) professional trade association of independent doctors in South Carolina, is dedicated to preserving both the esteemed profession of medicine and the vital doctorpatient relationship. We extend our heartfelt gratitude to our sponsors, whose unwavering support directly connects them with independent primary care and specialty physicians throughout the state.
Your sponsorship is not only a powerful marketing asset that elevates your brand or business, but also a unique opportunity to forge lasting relationships and showcase your products and services to South Carolina’s premier independent physicians. Thank you for partnering with IndeDocs and for investing in the future of healthcare in our community.
www.indedocs.com/sponsorship Explore more about our sponsorship opportunities by visiting:
Founded in 2013, Wagenmaker & Oberly serves nonprofits across the United States and internationally, from charities and churches to schools, health care facilities, and tax‑exempt organizations.
With a deep commitment to integrity, transparency, and respect, Wagenmaker & Oberly provides high‑quality legal services that help their clients fulfill their unique missions.
Their practice is shaped by core commitments that set them apart: Excellence: Delivering meticulous work and a clear, transparent billing process.
Integrity: Treating clients, colleagues, and the broader community with honor and respect.
Service: Engaging fully with the communities they serve through meaningful relationships, teaching, pro bono service, and generosity.
For nonprofits, Wagenmaker & Oberly offers expert guidance in areas such as:
Employment‑related legal matters
Corporate governance and best practices
Federal tax‑exemption compliance
Other legal concerns affecting nonprofits
With offices in Chicago, Charleston, and Grand Haven, the firm advocates passionately for their clients across the nation, driven by the shared belief that a solid, pluralistic nonprofit sector is vital to a thriving civil society.
To support this mission, Wagenmaker & Oberly also maintains a robust online blog featuring valuable insights, legal updates, and best practices for nonprofits and their leaders. New content is added monthly, making it a go‑to resource for those navigating the evolving landscape of nonprofit law.
For more information, visit www.wagenmakerlaw.com and discover how their team can help your nonprofit achieve its mission with confidence and integrity.
Independent physicians across South Carolina are continually looking for innovative ways to enhance patient care, differentiate their practices, and diversify revenue. One of the most impactful but often underutilized opportunities is participating in clinical research.
Tribe Clinical Research, a collaborative network deeply rooted in South Carolina, showcases the many benefits of integrating clinical trials into independent practices.
“Clinical research is not just about advancing medicine, it’s about offering tangible hope to patients,” says Dr. Scott Dobson, Medical Director and a Principal Investigator at Tribe Clinical Research. “By bringing cutting-edge treatments directly to our local communities, we ensure patients receive care that is truly on the forefront of medical advancement.”
One key benefit of clinical research is access to innovative treatments that patients might not otherwise receive. This sets a practice apart in a competitive market, highlighting a commitment to progressive, patient-centered care.
“Clinical research positions independent physicians as leaders and innovators in their field.”
-Dr. Ron Mayfield, Principal
Investigator, Tribe Clinical Research
“Patients value practices that offer advanced and unique treatment options,” says Dr. Ron Mayfield, another Principal Investigator at Tribe. “Clinical research positions independent physicians as leaders and innovators in their field.”
“Participation in clinical trials can also offer financial sustainability when structured in accordance with fair market value and regulatory guidance, helping physicians diversify revenue streams while maintaining compliance,” notes Dr. Justin Moll of Tribe Clinical Research. “When appropriately integrated, clinical trials can provide a supplemental revenue opportunity for practices.”
For physicians unfamiliar with clinical trials, partnering with an experienced research group is key. Tribe offers full-service support—from patient recruitment to regulatory compliance—making the process streamlined and accessible. With a patient network exceeding 100,000, Tribe empowers independent physicians to incorporate research seamlessly into their daily workflow.
“Our collaborative model removes the barriers to participation,” explains Jennifer Lehman, RPh and CEO at Tribe. “We handle the logistics so that physicians can stay focused on delivering excellent care and improving outcomes.”
For independent physicians in South Carolina, partnering with Tribe Clinical Research offers a clear path forward. Clinical research enhances care, advances medicine and supports the financial health of private practices—all critical components to thriving in today’s healthcare landscape.
The independent practice of medicine is a viable alternative for all specialties. It takes an organization that believes in this and is committed to promoting and facilitating this option.
Visit our website to learn more about becoming an IndeDocs member: https://indedocs.com/membership/
OUR MISSION OUR MISSION AND VALUES: AND VALUES:
To promote and protect the doctor-patient relationship by preserving the professionalism of medicine through independent practice. IndeDocs serves its member physicians to facilitate the delivery of the highest quality and most cost effective medical care.
Membership opportunities:
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