Physician autonomy has become a core concern as the workforce faces growing consolidation, with large healthcare systems, corporate entities and insurance companies increasingly influencing clinical decision-making and operational practices.
Around 108,700 physicians left private practice for employment between 2019 and 2021, according to a report from Avalere. And in 2022, just 44% of physicians owned their practice, compared with 76% in the early 1980s, according to a report from the American Medical Association.
Six physician leaders joined Becker's to discuss how physicians can get their autonomy back.
Question: Amid the erosion of physician autonomy, how can doctors get their power back?
Editor's note: These responses were edited lightly for clarity and length,
Michael Gomez, MD. NICU Medical Director of Pediatrix Medical Group (Long Branch, N.J.): Physicians get their power back by outperforming, outworking and staying current on developments in their specialty and in medicine in general. It's easy to get overwhelmed or lost in the duties of clinical practice, but physicians must find time and resources to develop all the other skills needed to perform well in health care. It's certainly not for the faint of heart.
James Lee Krantz, MD. Family Medicine Physician at Catoctin Medical Group (Frederick, Md.): I think the main source of erosion of physician autonomy is the entry of businesspeople into medicine, which we physicians very much facilitated several decades ago. One very doable strategy to empower physicians is to make it more economically feasible to run a private practice. A change that could immediately affect this is to give physicians in private practice the same facility fee that hospital-owned practices routinely receive.
Evan Pollack, MD. Internist in Westchester, Pa.: I do not feel that physicians strive to have their practices taken over by corporate entities. If one follows the trajectory, most of the practices that are taken over are struggling financially; some are on the verge of going out of business. I would say that it is mostly out of necessity that physicians sell their practices and become salaried employees. Presently, over 70% of physicians are employed, and physicians coming out of training are comfortable with that arrangement. In order for physicians to regain their power, they would need to be in control of their own practices once again.
Often, we see that the priority in healthcare is not patient care but profit. Almost all commercial payers employ physicians, and United is the largest employer of physicians. What is needed, I feel, is a public option government health plan to reduce some of the reliance on commercial payers and increase the possibility of success for physician-run practices. Alternative payment models, which are already being tried, are certainly an important component as well. Healthcare should be reimbursed based on the ability to care effectively for patients, not just on generating profits. Reducing physician debt as they come out of training would also help allow physicians to concentrate more on patient care and less on reimbursement.
Marc Shelton, MD. Associate Professor of Cardiology at the University of Missouri Health System (St. Louis): The most important factors to hospital systems from a physician relationship standpoint are, of course, quality, but also size and essentiality: the size of the individual practice or service, margins to the hospital for the efforts and whether the service is needed 24/7 for the hospital to continue its mission. Ideally, physicians and hospital systems would work together to find win-win solutions that improve quality, service and margins simultaneously. I believe that physicians will regain autonomy when trust is built with the systems in that way, as opposed to through more adversarial negotiations or union-like standpoints. Neither hospitals nor physicians can get everything they want unless they work together.
The inevitable, looming and worsening physician shortages will force hospitals to be more open to collaboration, and physicians could leverage that moving forward more than they have in the past
Sheldon Taub, MD. Gastroenterologist at Jupiter (Fla.) Medical Center: Doctors need to become more politically active, and they need to organize in a way that garners public support. Society needs to understand the importance of a strong, accessible and affordable healthcare system. Physicians need the support of the government without a financial obligation to repay that support. Unfortunately, there is no national organization of physicians that is politically strong enough to do this.
Grace Terrell, MD. Chief Medical Officer of IKS Health (High Point, N.C.): Physician autonomy is misunderstood. It shouldn’t be seen as a "lone-actor doing whatever she wants" paradigm. Rather, it is about having the authority and capability to act in the best interests of another human being — her patient — in providing medical care. That can be done in private practice, group practice, academic practice or as part of a giant integrated delivery system. Physicians regain our power by doing what’s best for patients and holding those who get in the way accountable.
For me, that means practicing medicine based on the best evidence as part of a team focused on whole-person care. It also means working to redesign clinical and administrative workflows that are efficient and human-centered, rather than built to accommodate the tyranny of inadequate clinical and administrative technologies. Additionally, it means working as a leader in advocacy and policy to harmonize care models and payment models for the best patient outcomes.