Over the last 10 years, 77% of physicians have shifted away from independent practice and into employed models.
This shift has taken place alongside a spike in consolidation throughout healthcare. According to the Physician Advocacy Institute and Avalere Health, 58.5% of practices are health system- or corporate-owned.
Employed physicians also report feeling higher levels of burnout, anger and anxiety compared to their independent counterparts, according to a recent Physician Foundation survey. This is sometimes linked to a lack of physician autonomy, as 61% of employed physicians said they have moderate or no autonomy to make referrals outside of their practice or ownership system, and 47% say that they adjust patient treatment options to reduce costs based on practice policies or incentives, according to a survey from NORC at the University of Chicago.
This story is all too familiar for Susan Baumgaertel, MD, an internal medicine physician in Seattle. For 25 years she worked as a physician and had ownership stake at The Polyclinic in Seattle, a multispecialty physician practice now owned by Optum. The facility is currently rebranding itself as Optum Care Washington. Prior to Optum's acquisition of a controlling share in The Polyclinic in 2019, the practice was growing quickly and offered a wide range of services.
While Dr. Baumgaertel never served in the practice's C-suite, she was chief of primary care at one point and served on numerous committees.
"Everything was always 'grow bigger, grow bigger, grow bigger,' because growing bigger meant that we would be a bigger fish in the pond, which means it would be more favorable when we negotiated contracts with insurers," she told Becker's.
As the practice grew bigger, Dr. Baumgaertel felt an increasing lack of autonomy in her ability to make clinical or operational decisions in the best interest of her patients and staff. One major factor in that frustration was an increasing pressure to accept and bill patients under Medicare Advantage, a policy many physician leaders have expressed frustration with.
This shift in focus took place alongside other slow, yet noticeable changes in day-to-day function of the clinic, despite initial promises that the partnership would not impact the clinical side of the practice.
"Those little, tiny examples, don't seem like much, but that's where it started," Dr. Baumgaertel said. "And then it would expand, expand, and then, of course — bam — COVID hit."
Dr. Baumgaertel left The Polyclinic in 2021.
"I could not see myself going forward [at The Polyclinic] in a way that was being true to my moral and ethical code," she said.
Dr. Baumgaertel left her position without a serious plan of what she would do next.
"I walked away from a really high-end income to earning zero. I guess I'm privileged that I could do that. Not everyone can do that. But I thought, I've got to sleep for a couple weeks, regain my sanity, start to get my creative juices back, and then dream about what I want to do," she said.
Knowing she wanted to keep working in medicine, she orchestrated two virtual focus groups over Zoom, each made up of 25 of her former patients, and tested ideas about what sort of practice would serve their healthcare needs and make practical financial sense.
"I knew I didn't want to bill insurance," she said. "That was a biggie."
Her new independent practice, myMDadvocate was born out of those focus groups and serves as a multifaceted telemedicine and healthcare navigation hub.
"I realized that the answer was staring me in the face. The problem with our healthcare system is it's just broken. Try to get healthcare, try to access healthcare, try to get to a doc. Try to find a doc.Try to find someone who actually knows what they're doing. Try to find someone who has time, who's not booked out for many months, someone who cares, who listens to you, and all those things that we, the physicians, went into medicine to care for people," she said.
Dr. Baumgaertel bills for her time, likening her business model to that of a law firm where lawyers bill for their hours worked. While initially worried that this model would only cater to wealthier clientele, as her services are not covered under insurance, Dr. Baumgaertel found that many of her patients find her services helpful on the basis of having a physician that they can access more easily than their regular primary care physician, or having direct access to someone who can help them navigate their own insurance and healthcare options.
"People use me for different purposes. It could be for acute illness or chronic illness management. It could be management of their aging relatives or their spouse, who's maybe having some dementia," she said. "It could be someone who has cancer and they don't know where to go. It is really gratifying that I can handle all those things,which I've always done in internal medicine, but I now do it on a virtual platform."
Her average patient is older, typically in their 60s and 70s, a time when people often need more regular access to healthcare. Dr. Baumgaertel has found the new practice model truly transformative for her relationship with patients and her relationship with her own autonomy as a physician.
"I'm really humbly impressed with people who are even on a fixed budget, have to be mindful of where their money goes," she said. "And they decide it is worth paying me because they value their health, and they appreciate what I can contribute to their health care beyond what our system is not doing a good job of."