Physician autonomy is top of mind for Vladimir Sinkov, MD, founder and CEO of Las Vegas-based Sinkov Spine Center.
Dr. Sinkov, who was previously employed in a large group practice, said he "regained" his independence after he opened his own practice in June 2020.
"Now that I’m independent, I'm very passionate about it," he said. "I wish more doctors would follow suit, as the quality of care would improve. We need to understand how the entire healthcare system works to maintain our independence and focus on patient care."
Dr. Sinkov joined Becker's to discuss four ways physicians lose power and what they can do to get it back:
Signing contracts
Signing contracts is one of the biggest ways physicians can lose power, Dr. Sinkov said. These contracts are "in exchange for something valuable" like being in a network with a payer, which is necessary to secure a patient base, but physicians must tread carefully.
"Contracts contain obligations, and by definition we lose independence because we give it up," he said. "Nowadays, the rewards of those contracts, in terms of patient volume and money, don't match the amount of rules, regulations and restrictions placed on us as physicians."
Dr. Sinkov recommends avoiding signing contracts unless absolutely necessary. For the contracts that do exist, he advises reviewing them and canceling the most restrictive ones.
State and federal laws
Physicians also lose power through laws governing practice at the federal and state levels, which "are tougher to deal with," Dr. Sinkov said
Physicians can lobby and vote, but most are too busy to spend time talking to politicians, he said. Physicians also do not "have enough lobbying money compared to other interest groups in medicine, like hospitals, attorneys and insurance companies."
Many of the restrictive laws are tied to accepting Medicare, so physicians can regain some control by no longer taking Medicare patients. Dr. Sinkov said he stopped accepting Medicare patients in 2022 and found that "many rules and regulations go away because those laws apply to Medicare patients."
For laws physicians cannot change, Dr. Sinkov recommends becoming familiar with them.
"If you don't have time to manage this yourself, hire knowledgeable staff to help you navigate these regulations," he said. "This will allow you to practice more independently."
Decreasing reimbursements
Physicians are also affected by decreasing reimbursements; Medicare reimbursements have been declining for decades and health insurance contracts are tied to what Medicare reimburses.
Earlier this year, Congress cut physician pay rates under Medicare Part B by 1.7%, following a 2% cut in physician reimbursements in 2023. Earlier this month, CMS proposed to cut physician pay even further.
"If you’re reimbursed less for your work, it becomes harder to negotiate for resources like equipment, and you lose financial independence," Dr. Sinkov said.
He recommends refusing to sign contracts that decrease reimbursements and that "evaluating how much you're willing to provide services to Medicare patients when payments keep dropping is essential for maintaining independence."
"In the U.S., I don't know of any other profession where professionals are getting paid less now than they were 20 years ago," he said. "We are highly trained professionals, but we allow ourselves to be paid less and less. This makes no sense."
Physician competition
A "self-imposed" issue that stymie physicians is that they compete with each other more than do with other entities.
"We're so used to competing in college, medical school and residency that it becomes a habit," he said. "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. Because federal law prevents physicians from unionizing and lobbies do not effectively represent physicians' interests, in his opinion, collaboration is necessary.
"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."