About 77% of physicians have moved away from independent settings and into employment by hospital or health systems. But recent developments indicate that some may be reconsidering their independence.
Consulting firm Bain & Co. recently released its "Frontline of Health Survey" in an October blog post, which highlighted that nearly 25% of physicians in health system-led organizations are debating a change in employers, compared to 14% in physician-led practices.
Many physicians cite reasons such as reimbursement declines, regulatory burdens, a lack of leverage with payers and soaring practice costs as reasons for shifting to independent practice. But Bain's survey suggests that physicians are increasingly less satisfied with this tradeoff.
Among physicians in physician-led practices, 78% said their organizations have effective processes and workflows, compared to just 59% of those in hospital-led organizations. Those in physician-led practice also reported 81% satisfaction with their involvement in strategic decision-making, compared to just 50% in hospital-led practices.
The study highlighted several professional factors in hospital-led settings — including compensation, staffing levels, workload and autonomy — as having "disproportionately high potential to disappoint or delight."
Autonomy was a central concern for Susan Baumgaertel, MD, an internal medicine physician in Seattle, who decided to depart from her former employer after 25 years when it was integrated into a larger health system.
"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 of that frustration was an increasing pressure to accept and bill patients under Medicare Advantage, a policy that has become a source of frustration among many physician leaders.
This shift in focus took place alongside other slow, yet noticeable changes in day-to-day clinic functions, despite initial promises that the partnership would not impact the clinical side of the practice.
Dr. Baumgaetel began her own independent practice, myMDadvocate, in 2021, which focuses on telemedicine and healthcare navigation. She bills hourly for her time directly to patients, subverting the need for contracts with payers.
Robert Bray Jr., MD, CEO and founder of Newport Beach, Calif.-based DISC Sports & Spine Center, told Becker's that physicians must "gain a position of power" in order to regain their independence and autonomy in a sustainable way.
"The only answer I have found, which is actually the basis of why I created our structure, is we take a bunch of private practice physicians and affiliate their corporations through a management contract," Dr. Bray said. "We're selling them a service, but what we're doing is we are negotiating as a whole with the insurer to get enough power bundled. We're able to put the surgeon first. It's giving the physician some say, in essence, by bonding together as a group."
Dr. Bray said that the strength of this strategy lies in the fact that the larger management contract is with other physicians as opposed to "a couple of senior partners who are taking advantage of the junior guys coming in."
"That's happened to a lot of the groups we've seen. You need a physician-first model. And we've found it's cost efficient to do this," he added. "We've left them their autonomy, but we're incentivizing them to make cost-efficient decisions, as opposed to just making a decision to survive price breaks because they've been squashed by declining rates. They get paid fairly. They still have to work hard, but it's still a very cost-efficient number.