On the front lines of health care, parts of the year 2021 were “bananas.”

That’s one of the ways Wilmington-based physician Umar Bowers describes the hectic nature of that time, a period when the Omicron variant of global pandemic culprit COVID-19 swept through the U.S.

Umar Bowers and nurse practitioner Tiffany Bowers, Umar’s wife, opened Dawson Med, which includes an urgent care and primary care practice, in August 2021.

In the health care industry, independent practices like Dawson Med come with numerous challenges and benefits as mergers and consolidations with bigger organizations remain a trend.

The pressure to deliver results sooner, for example, can be greater.

For a larger system, “if that one primary care office that’s new on the other side of town doesn’t meet its initial targets, well, the health care system is not going to crumble, right?” Umar Bowers said. “We knew that we had to see patients and generate revenue and produce as an entity, or we wouldn’t be able to survive.”

The need for Dawson Med’s urgent care practice to respond to the Omicron variant overshadowed any worries about how quickly the primary care side could get off the ground.

“On the urgent care side, we were busy right away,” Umar Bowers said, mostly with COVID testing and treatment.

Umar Bowers said he hopes to never see days like those of the pandemic again. Within two or three months of opening on Dawson Street, Dawson Med’s urgent care had “lines out of our parking lot backing all the way to the (Cape Fear Memorial Bridge), and we had to call the Wilmington Police Department for traffic control,” he said.

Four years later, the Bowers’ practice has normalized to patient care outside the hectic days of the pandemic, and Dawson Med has established its own base.

But because of their smaller number, independent doctor’s offices like Dawson Med can be seen as islands surrounded by larger health systems’ provider networks.

Health care consolidation and absorption of independent medical practices by larger health care companies and systems has been an ongoing trend for multiple decades.

“Over the past five years, nearly 75,000 physicians have shifted from private practice to employment within hospitals and large health systems,” wrote Paul Berggreen, chairman and president of the board of the American Independent Medical Practice Association, in an opinion piece published by the Savannah Morning News this year.

The editorial’s focus was on the impact of Medicare physician reimbursement declines.

“Doctors in independent practice have now endured five straight years of Medicare payment cuts,” Berggreen wrote. “The expenses required to keep a practice running are climbing – they’re projected to rise 3.5% this year alone. After adjusting for inflation, Medicare’s payments to physicians have dropped by roughly 33% since 2001.”

Medciare reimbursements are a big concern for independent physicians, said Gregory Bebb, a surgeon at Wilmington Surgical Associates.

“Whenever the government is involved in something, as one of the parties to the business, they can write laws, change budgets, change reimbursement to favor one side versus the other, and so, over the past several years, they had decreased payment to private physicians and increased payment to employed physicians, which is quite unfortunate,” Bebb said.

He said one of the benefits to patients of independent practices is the ability of smaller practices “to move a little easier. It’s like a small boat moves easier than an aircraft carrier.”

Wilmington Surgical Associates surgeons have admitting privileges at Novant Health New Hanover Regional Medical Center, “and the hospital has done well by us because we have very good outcomes because of the quality of surgeons that we’ve hired,” Bebb said.

The costs and other stressors of striking out on one’s own aren’t new to Umar Bowers.

“The pressure to be able to execute is something I lost sleep over,” Umar Bowers said of starting Dawson Med. “But … this is not the first business I’ve started, so that’s just kind of how it works. When you’re starting a business … if you’re sleeping well every night as an entrepreneur, you might be a little too comfortable.”

On the primary care side of Dawson Med, maintaining an office independently has been eased by working with Aledade Inc., a network of independent primary care, said Umar Bowers, who is a national ambassador for Aledade after previously serving as a local medical director. According to Aledade’s website, Aledade’s accountable care organizations (ACOs) “help practices and health centers improve patient outcomes and generate sustainable revenue.”

“Yes, we’re independent but we’re not entirely alone,” Umar Bowers said.

One local exception to the national trend of consolidation is Wilmington Health, an independent practice that is physician-owned. With multiple sites and 300 providers, the practice has worked on projects to collaborate with other practices around the county, particularly helping those running their own ACOs.

Ellis Tinsley, president and CEO of Tinsley Surgical in Wilmington, is a second-generation independent practice surgeon who has seen health care undergo major changes since he was a nursing assistant at age 14.

“As systems for delivery and payment become larger, more business-oriented and more bureaucratic, the actual care at the bedside and in the office is challenged. We keep throwing out the good with the bad,” Tinsley said. “The healing nature relationship between care receiver and caregiver is reduced by distraction. As an independent, I have more control over the environment and the excellence that becomes the patient experience.”

He said his practice also allows him to rapidly use technology, be financially independent and create a work environment consistent with his beliefs and values, Tinsley said.

Because doctors have always been at least partly trained in hospitals, some tend to want to practice in the environments in which they were trained, Tinsley said, and once they are employed physicians, it can be hard to know how to make the transition. New coaches, software and consultants, however, have made it easier, he said.

“There is renewed interest in independent practice and many more ways to participate,” Tinsley said.

The pressures independent practices might feel to join health systems tend to be all financial, he said. It’s important to hire a good team, Tinsley said.

“You have to have great people around you that understand the basic principles of business but who value your work as a clinician and want to combine their skills with your skills. It really is two different languages that you have to learn, but it is essential that the clinician learns how to speak business,” he said. “Once you do it, it is incredibly rewarding.”

Tiffany Bowers was born at what is now Novant Health New Hanover Regional Medical Center. When the building at 608 Dawson St. in Wilmington became available, the Bowerses decided to move full time to the area from their previous home base in Charlotte.

“It’s been really nice being able to see some people that I’ve known since high school who randomly come to the clinic,” said Tiffany Bowers, who grew up in Rocky Point, graduating from Pender High School, and had a job and friends in Wilmington.

One of the challenges Tiffany Bowers has been working on is getting Dawson Med’s name out, particularly the urgent care side now that COVID is under control, to all of the people the office can serve.

“We take care of everyone … We serve the entire population,” she said. “We serve Leland. We serve the greater Wilmington area. We serve people who are just traveling. About half my day is spent with travelers vacationing or visiting. And so just getting more brand awareness and getting our name out there more would be one of the biggest challenges we’re having now.”

The Bowerses said some of the benefits of being independent are being able to take care of a team, developing a workplace culture of their own and helping staff members develop their careers. Dawson Med has six providers – one doctor (Umar Bowers), two nurse practitioners (including Tiffany Bowers) and three physician assistants.

“We’ve seen over the past nearly four years several team members grow personally and professionally,” Umar Bowers said.

Dawson Med has been able to leverage resources to accomplish this feat.

The South East Area Health Education Center (SEAHEC) “has been amazing as a partner with us,” Umar Bowers said.

SEAHEC is a nonprofit organization, part of the N.C. Area Health Education Center, that aims “to provide and support educational activities and services with a focus on primary care in rural and under-resourced communities,” according to its website.

Umar Bowers said, “We have been really intentional about being independent, which we’re passionate about, but also being collaborative.”