The number of private practices is rapidly declining as physicians continue to migrate to employed models.
Here's what five physician leaders have recently said about the decline of private practice:
Adam Bruggeman, MD. Orthopedic surgeon at Texas Spine Center (San Antonio): Let’s be honest, the practice of medicine by physicians is under a multi-front assault. We are on the brink of a fifth consecutive cut to physician pay next year. Prior authorization is expanding at exponential rates. Inflation has led to dramatic increases in the cost of doing business, particularly for staffing. Documentation, outcomes measurements and the general administration of practices continue to expand and outstrip resources. All of this is happening while Congress blocks physicians from owning hospitals and provides benefits to hospitals that purchase practices by allowing higher payments for the same services when provided in a hospital outpatient department. To say the deck is stacked against physician practice is an understatement. I am watching the various efforts to combat consolidation, which has been a cancer to our profession and to the health of our nation.
Quentin Durward, MD. Neurosurgeon at the Center for Neurosciences, Orthopaedics, & Spine (Dakota Dunes, S.D.): You don't survive in private practice without very, very good patient outcomes. You're dependent on your reputation in the community, and you're dependent on doctors referring to you because they know they can trust you, and they've seen your work in their own patients. It's very different when there's an employment model, whether it's a university-based system, a large group practice or hospital-based system, the system is the one that has the reputation. Physicians can coast in a situation like that. They can basically be much less apparent to the doctors referring to the system, or they are guaranteed referrals by doctors who are employed by the system. In my opinion, you need to be as nearly on your toes and maintain the very, very best standard you can if you're in a private practice model vs. an employment model, because if you're not good in a private practice model, you sink.
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.
Jason Rosenberg, MD. Pain medicine specialist and neurologist at SC Pain & Spine Specialists (Myrtle Beach, S.C.): What scares me about the future of medicine is the loss of the independent physician. I’d like to think AI would be to blame, yet this is not the case. Inflation with resultant increased cost of conducting business, salary battles with local health systems over trained employees and declining reimbursements are some of the major factors. Add in the demands from private insurers with prior authorization and now post authorization, the hurdles to practice medicine independently only grow larger.
Vladimir Sinkov, MD. Founder and CEO of Sinkov Spine Center (Las Vegas): Physician autonomy has declined significantly since the advent of Medicare in the 1960s. When physicians become employees, they are often asked to see more patients, which reduces the quality of care. No matter how skilled a physician is, seeing more patients per day inevitably lowers the quality of care. Access to care also decreases if physicians are owned by entities that limit who can see them. Overall, healthcare costs go up because the entities that own physicians focus on maximizing profits. This applies to both for-profit and nonprofit hospitals and insurance companies.