Autonomy is a critical element of a physician's career, and according to healthcare leaders, market factors such as consolidation and private equity have limited the longevity of independent physicians.
Here are three leaders' thoughts on the state of physician autonomy in 2024:
Cary Passik, MD. Chief of Cardiothoracic Surgery at Good Samaritan Hospital (Suffern, N.Y): I believe the biggest threat to physicians is the progressive loss of autonomy such that they are not making the decisions for the patients, but those decisions are made for reasons and by people for other than the patient's benefit. I think the administrative burdens of being a physician have become so onerous, where physicians are becoming a scribe of medical records, such that the patient-physician relationship is being progressively destroyed.
Vladimir Sinkov, MD. Founder and CEO of Sinkov Spine Center (Las Vegas): The main reason the physicians are increasingly dissatisfied with their career in medicine is the feeling of lack of control over their work and ability to take care of their patients. Due to declining reimbursements and increasing regulatory and nonclinical burdens, more and more physicians decide to become employees of large organizations (hospitals, insurance company affiliates like Optum or Kaiser or mega-groups controlled by venture capital firms). Once they become employees, a significant amount of clinical and career autonomy is lost. The initial increases in salary eventually become diluted by ever-increasing "production" requirements, and physicians then feel trapped in a job they do not like but can no longer leave (don't forget the noncompete clause).
The reforms that could potentially abate this should include medical malpractice reforms, increase of reimbursements for medical services back to reasonable levels dictated by current market forces, and reforms that would decrease regulatory burdens so that physicians can regain their independence in clinical practice.
Calvin Wong, MD. Cardiologist at Pacific Cardiology (Honolulu): [In practicing independently], I have this flexibility to do what I think is right. I'm not obligated to send the patient to the hospital that employs me. I can send who I think is the best doctor for that particular patient … so therefore it's a question of patient fit. The cornerstone of independent practice is the doctor-patient relationship. In Hawaii, which is very multicultural, if I have a Chinese-speaking patient from China, I'm gonna send him to this Chinese-speaking doctor in Chinatown. I can match the patient to the background.