The physician autonomy problem

Physicians are independent creatures. They thrive off of the ability to make the best decisions they know will provide the best outcome. But as the number of independent physicians dwindles, what becomes of physicians' autonomy?

In 2022, just 44% of physicians owned their practice compared with 76% in the early 1980s, according to a report from the American Medical Association.

Reasons for this change likely have to do with rising operating costs and large amounts of student debt, which can hinder new physicians from practicing privately. 

Private practice allows physicians a sort of autonomy that is not found elsewhere. 

"I have this flexibility to do what I think is right," Calvin Wong, MD, a cardiologist at Pacific Cardiology in Honolulu, told Becker's. "I'm not obligated to send the patient to the hospital that employs me. I can send who I think is the best doctor for that particular patient … so therefore it's a question of patient fit. The cornerstone of independent practice is the doctor-patient relationship. In Hawaii, which is very multicultural, if I have a Chinese-speaking patient from China, I'm gonna send him to this Chinese-speaking doctor in Chinatown. I can match the patient to the background."

Physicians crave the ability to make the decisions they see fit. According to Medscape's "Employed Physicians Report 2023," 56% of employed physicians said that what they like least about their jobs is less autonomy. 

When this autonomy is lost, it can lead to discontent and burnout. According to Medscape's "Physician Burnout & Depression Report 2024," 32% of physicians reported being burnt out due to lack of control or autonomy.

So in a world of increasingly employed physicians, what does the future of physician autonomy look like?

"Physicians remaining independent are going to be few and far between. They're either going to go with these large equity groups or hospitals or something like that," Sheldon Taub, MD, a gastroenterologist at Jupiter (Fla.) Medical Center, told Becker's. "You still have a quote, unquote, "private practice," but you have guidelines and rules that you have to conform to so it meets their criteria. So right away, you feel a little bit of your autonomy being compromised, and then the bigger the group gets, the more restrictions they have on what you can do to stay in the group and conform to what they want you to do. On top of that, the government throws in their regulations too. The private practitioner is a dying breed."

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