Editor’s note: This response was edited lightly for brevity and clarity.
Question: Why don’t private practice physicians have more power in healthcare?
Dr. Kenneth Nelson: Physicians have historically let administrators manage hospitals and health systems. As more physicians become employed, the collective (voice) power of independent physicians is being marginalized. The clinically integrated network and ACOs are staffed with health system administrators. Most chief medical officers and most physicians in top health system roles are more administrators than physicians.
I read somewhere that in the last several years, 36,000 medical practices have been sold. Only 6,000 have been bought by health systems. The entrepreneurial independent physician, after being swallowed up by a large group, then falls victim to consultants and a top-down decision process that moves decisions from the exam room to the boardroom. Most of these companies and health systems take a very good successful small business and try to treat it like traditional service lines. It just doesn’t work.
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