'It is a dirty business': How private practice physicians have lost power

Kenneth Candido, MD, CEO and president of Chicago Anesthesia Associates, joined Becker's to discuss why private practice physicians don't have power in healthcare. 

Editor's note: This response was edited lightly for clarity and length. 

Dr. Kenneth Candido: Private practice physicians are becoming more and more rare in American healthcare. This is by design and is not random. Large systems are siphoning off private practice physicians and are buying or consolidating practices exponentially. Those who hold out find a shrinking referral base, as those formerly loyal to them are being compelled to exclusively refer within the system. It is a dirty business and a dirty, underhanded game that administrators are playing to monopolize their business models. 

Physicians "in the system" are punished if they refer to outside, private practice physicians. They have bonuses cut or undermined or have other sanctions placed upon them. The referral process has been weaponized. The hospital systems have created a monopolized system that demands their own "growth" to the exclusion of any competition in their areas. This monopolization is largely tolerated by the enforcement of noncompete clauses and legal loopholes that in any event do not attract the government oversight, since they are in collusion with the major health systems to eliminate privatization or care and to move rapidly towards socialization of care. The private practitioner, unless they are in plastic surgery or dermatology, are essentially dinosaurs on the road toward extinction. The old mantra of "divide and conquer" has been expertly used by the major healthcare systems to pick off the lone or small group practitioners, and has been extremely lethal and effective. 

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