The 'marginalized' physician: 5 thoughts on loss of power

As healthcare continues to consolidate and physicians migrate to employed models over private practice, some leaders worry about the loss of physician power. 

Here are five leaders' thoughts on physicians losing power. 

Brian Curtin, MD. Orthopedic Surgeon at OrthoCarolina (Charlotte, N.C.): First and foremost, physicians have to take on leadership roles within healthcare systems such that there is a voice advocating for patients and patient care. Many systemwide healthcare and policy decisions are made in meeting rooms full of hospital administrators or politicians with little clinical background and little understanding of repercussions on patient care. 

Our professional organizations also have to remain engaged in advocacy efforts to ensure healthcare regulation and policy development is physician-led. This requires time and commitment from physicians to these organizations and the collective voice is far more powerful than any one physician alone. 

Ismar Dizdarevic, MD. Orthopedic Surgeon at Ridgewood (N.J.) Orthopedic Group: Private practice is under attack from various fronts and will eventually succumb to defeat. It will impact access to quality healthcare as we perceive it today not just in the private practice realm but all models of healthcare as it will diminish the leverage physicians have in any negotiations.  

Insurers will have lowered reimbursements to the level of non-sustainability under the guise of "value" while demanding more resources from the practices in terms of prior authorizations, documentation and denials. Private practice physicians will be left with a decision to either stop accepting lower reimbursing payers, namely Medicare; become employed themselves; join larger single specialty or multispecialty groups; or subscribe to the growing although limited field of cash/concierge medicine. 

Matt Mazurek, MD. Assistant Clinical Professor of Anesthesiology at St. Raphael's Campus of Yale New Haven (Conn.) Hospital: As we've become employed, not all of us sit on the boards of the hospitals as much, nor do we have as much representation in the C-Suite. If you were in private practice, you were the COO, the CEO, etc. Frankly, for most of history, at least in the U.S. healthcare system, these businesses courted physicians. So to court the physicians means they have to be listened to as well — you have an inherent voice because they have an inherent interest in retaining you and recruiting you. Now that we're employed, and then when we have a noncompete, well, where are you gonna go anyway? They don't have to really listen to you. 

Additionally, now you don't only not have a voice, but you can frankly be abused through overwork or unreasonable production pressures and that sort of thing. I think we need to take a little bit more of that power back and realize that we're, for lack of a better word, cogs on this corporate wheel and we weren't cogs, you know, 20 to 30 years ago at all.

Kenneth Nelson, MD. Chief Medical Officer of UChicago Medicine AdventHealth Medical Group (Westchester, Ill.): 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.

Harry Severance, MD. Adjunct Assistant Professor at Duke University School of Medicine (Durham, N.C.): Physicians have been marginalized into "employee status" in our increasingly mega-health system corporate structures. They are found on less than 14 percent of any major hospital/health system top decision-making boards (and it is suspected that the majority of those leaders no longer see patients), and have been removed from any significant major decision-making positions in most hospital systems. There are increasing reports that many mega-corporate hospital system leaders see physicians (and nurses and other healthcare workers) as an oppositional force. They face increasing violence within their workplaces, as well as denigration, overwork, burnout and abuse, in many workplaces, even from their own managers and administrators. 

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