Physicians told Becker’s that the next major shift in medicine won’t be a new device or breakthrough drug, but the accelerating shift from fee-for-service to value-based purchasing.
Cost pressures, patient frustration and employer fatigue are converging in ways that may force a structural reset in how physicians practice and get paid, several said.
Steven Rich, MD, a geriatrician in Rochester, N.Y., said value-based purchasing will prove to be the greatest disruptor over the next five years.
“Fee-for-service still is the dominant paradigm for clinicians and health systems, but the runway is short, and the can cannot be kicked down the road much longer,” he said.
Dr. Rich pointed to the last time the U.S. meaningfully slowed healthcare spending growth — the HMO boom of the late 1980s and early 1990s. Though unpopular, he said, those models were built on “having broad-based, properly incentivized primary care physicians at the helm” who were empowered to manage cost and quality simultaneously.
At the time, most physicians were self-employed and connected through independent practice associations, structures that no longer exist at scale. Over the past two decades, he said, those functions have been dismantled. Advanced practice practitioners have been leaned on to fill gaps, and physician training and employment models have shifted in ways that make balancing high-quality primary care with cost control increasingly difficult.
Rebuilding that function will require new relationships and new infrastructure, Dr. Rich said. Many accountable care organizations are health-system-based and still tethered to hospital-driven volume incentives.
Mary Meyer, MD, an emergency medicine physician in Dublin, Calif., said she sees a cultural tipping point forming around cost and access.
“There is just so much anger and frustration with the current state of healthcare — I think we’re reaching a tipping point,” she said. Every day, I meet people who are dumbfounded at the cost of their care. I have multiple friends who won’t leave jobs they hate because they worry about losing their healthcare.”
For Dr. Meyer, the shift to value-based care signals a potential realignment of incentives. Corporate medicine and large health systems will need to adjust priorities.
“Change is hard,” she said. “And this one means realigning health systems’ priorities so that they truly match our patients’ priorities.”
Brandon Ortega, MD, an orthopedic spine surgeon at Long Beach (Calif.) Lakewood Orthopaedic Institute, framed the disruption in economic terms.
“Historically, physicians were primarily compensated based on volume. That model is clearly evolving,” he said.
Payers and health systems are pushing toward predictable costs, measurable outcomes and efficiency across the entire episode of care. That shift informs how physicians think about operations, patient engagement and revenue stability.
The financially resilient practices will be those that adapt early by improving access, streamlining workflows and diversifying revenue beyond traditional clinic and surgical income, Dr. Ortega said. Data-driven reimbursement models reward coordination, performance tracking and cost control in ways fee-for-service never required.
