Pradnya Mitroo, MD, president of Fresno (Calif.) Digestive Health, joined Becker’s to discuss her insights on the biggest challenges physicians face in these transitions and whTat’s at stake as consolidation continues.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What do you see as the biggest challenge for physicians adjusting to hospital or private equity-backed employment?
Dr. Pradnya Mitroo: For the physicians who have gone into a hospital, I think the biggest challenge is adjusting to less autonomy, at least from the physicians I’ve talked to. There’s been a lot of change in our town, in Fresno. A large portion of primary care physicians moved into hospital-based employment, and then another large private-equity company came in and bought one of the oncology groups.
For the oncology group, I feel like it hasn’t affected them as much. So maybe, for specialty groups, the impact isn’t as significant. But for hospital-based groups, I think many went into it because they didn’t have to worry about overhead and administrative burdens. However, with that also came a loss of autonomy, especially regarding how much time they have with patients.
Initially, their first-year contracts guaranteed income, but after that, compensation became RVU-based. I’ve seen some of them struggling. Some have already left because, in the end, the hospital has to make money. Their first-year contracts were more lenient, but in the second year, they’ve had to take on more patients. Some physicians felt they couldn’t provide adequate quality care and faced too much administrative interference in how they ran their practice.
Q: What do you think is at stake if this trend continues — for physicians, patients and others?
PM: I think it’s terrible for both physicians and patients. For physicians, it’s a loss of autonomy. But for patients, it’s a loss of access in many ways because hospitals will have a monopoly and control how much they charge for services. I think costs will go up significantly.
Already, when we take patients to the hospital for procedures, it costs three times as much. And with so many insurance plans now being high-deductible, a lot of that cost gets passed on to patients. As private practices disappear, patients will have no choice but to go to the hospital, which will only drive costs higher. So I think access to care is going to become a bigger issue.
