As consolidation continues to climb across healthcare and more physicians find themselves working for hospitals and large health systems, physician autonomy persists as a central concern among physicians in employed settings.
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.
Additionally, around 61% of employed physicians said they have moderate or no autonomy to make referrals outside of their practice or ownership system, and 47% said 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 has led some physicians to consider a switch to private practice.
"Sadly, physicians realize, or think, that their power is gone and it's not," Susan Baumgaertel, MD, an internal medicine physician in Seattle, told Becker's. "I think that they have to think about options of where they really want to envision putting their incredible time, energy and experience and expertise into, in terms of helping patients."
For 25 years, Dr. Baumgaertel 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. She left the Polyclinic in 2021 to start her own independent practice, myMDadvocate, which serves as a multifaceted telemedicine and healthcare navigation hub.
A major reason that Dr. Baumgaertel decided to leave her former practice was a disruption of the patient-physician relationship due to the introduction of corporate policies and increased payer burdens.
"The physician patient relationship … it's a very intimate relationship," she said. "And no person or entity should come in between the physician and patient. A physician's loyalty is always to their patient. I think that this relationship has crumbled for so many reasons, the list is so long, but I think that reclaiming physicians autonomy is the foundation for curing the ills of our healthcare system."
The leap to private practice does come with major financial hurdles.
In November 2024, CMS finalized a 94-cent (2.83%) conversion factor decrease from 2024. The physician fee schedule conversion factor for 2025 is $32.35, down from $33.29 in 2024.
The investment required to support a physician practice rose 10% year over year in November 2024, reaching $332,957 per full-time equivalent physician, according to data from Strata Decision Technology. Median direct expenses per physician hit $1.1 million annually. Meanwhile, median annual net revenue per physician rose by 11.7% to $748,186.
However, other data suggest that there may be ways to mitigate the financial uncertainty that may come with independent practice. Self-employed physicians earn more than employed physicians overall, according to Medscape's "Physician Compensation Report 2023."
Self-employed physicians reported $374,000 on average, compared with $344,000 for employed physicians, according to the Medscape report. Physicians also reported being able to earn significant ancillary revenue as a private practice physician.
"Ancillary service revenue can reflect up to 50% to 60% of a private practicing physician's income, which, unfortunately, short of gain-sharing opportunities or partial ASC ownership, is usually unavailable in large healthcare system-employed practice situations," Jack Bert, MD, orthopedic surgeon at Woodbury (Minn.) Bone & Joint, told Becker's.
Partnerships with other, like-minded physicians and healthcare professionals who can align on strategies for practice management and growth can also prove to be a powerful tool in shifting to private practice.
"We're so used to competing in college, medical school and residency that it becomes a habit," Vladimir Sinkov, MD, founder and CEO of Las Vegas-based Sinkov Spine Center, told Becker's. "This weakens us, as we compete for patients, market share and resources while entities like hospitals, insurance companies and the government divide and conquer us."
Physicians must "organize, trust and collaborate more" to regain power, he said.
"Most collaboration happens locally or at the state society level but not beyond that," Dr. Sinkov said. "Uniting and refusing to sign bad contracts or accept decreasing reimbursements can help us regain power."
Collaboration and aligned values have proven key for Columbia (Mo.) Orthopaedic Group. The group has managed to stay independent despite strong consolidating factors in the ASC industry. Andrew Lovewell, CEO of Columbia Orthopaedic Group, told Becker's that independent practices can be designed to provide the more personal healthcare experience that patients already desire.
"The nice thing about that is, when the physicians are in control and they have more say in what happens, they actually can deliver better care," he said. "It's a tall order, but it can be done if you get the incentives aligned, especially with the physicians and the patients. If patients are getting better outcomes at a lower price, which is a higher value product, patients want to want that."