'They have become fearful': How physicians have lost autonomy

Kenneth Candido, MD, CEO and president of Chicago Anesthesia Associates:joined Becker's to discuss why physicians are leaving medicine.

Editor's note: This response was edited lightly for clarity and length. 

Question: Only 40% of physicians would recommend a career in medicine, according to a 2023 survey. What reforms are needed to abate this?

Dr. Kenneth Candido: This is based upon the recent trend of a total lack of autonomy as physicians become employed at an exponential rate. In the past, physicians had the ability to select their optimal work environment and the parameters upon which they saw patients. In the employment model, their schedules are determined by forces outside of their control and their referrals are made at the behest of an institution without regard to their preferences. Income is also not contingent upon effort but is predetermined by the corporation. Sanctions are made against independent thinking, including referring their patients to trusted outside consultants, which are punitive and demeaning. The corporation has its ultimate goal of maintaining control over all professional functions; the physician has lost decision making abilities. The corporation feeds itself from monopolizing the local markets. Even where superior outside consultants would better serve patients, the corporation prohibits it. The corporation does not care about patients besides what type of health insurance they may have. There is no attempt to maximize the best options for patients, rather the goal is to maintain exclusive control of the patient's entire health universe. The so-called "population health" model does not serve patients, it serves institutions and corporations. Physicians sit by and watch all this unfold and are helpless and impotent to address the fundamental flaws in this system, since in the end they have become fearful and have been forced into a dependent role. This dependent role is not what medicine was intended to be, and is not the medicine of our forefathers in any capacity.

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