'We sold our souls and have nothing': The unfulfilled promises in physician employment

Physicians continue to migrate to employed models as private practice costs rise. 

Matt Mazurek, MD, assistant clinical professor of anesthesiology at St. Raphael's Campus of Yale New Haven (Conn.) Hospital, joined Becker's to discuss how many physicians are left disappointed amid increased consolidation. 

Editor's note: Responses were edited lightly for clarity and length. 

Question: How does consolidation play into physician shortages as more and more migrate to employed models?

Dr. Matt Mazurek: Nearly 78% of physicians now are employed, and that percentage keeps creeping up. I think consolidation has not really produced the results that were promised by the consolidation. First of all, access has not improved. It's gotten worse. Second of all, costs have not reduced — it's actually increased across the board. I don't see consolidation producing all of the promises that were made when it was pitched with some health systems having approached the leaders in a particular community promising access to various resources. It really hasn't come to fruition. Same thing with the physician groups. They promised physicians if they joined they would have resources and funding, but I don't see that that's actually come to fruition either.

I think there has been a lot of hope and a lot of good ideas that at the end of the day, the money is being siphoned off for some communities into other areas without any return on the promises made. So everyone's kind of staring at themselves wondering what happened. We sold our souls and have nothing. It's a huge issue.

Q: What are the unfulfilled promises?

MM: The problem with physicians being employed is that the businesses of private practices have not been able to keep the lights on because of decreased reimbursements, high inflation and overhead, which is largely labor cost. So when these systems come in and say that they'll swoop in and save the practice, some are even hostile takeovers. They say nothing's going to change for the first couple of years, and while that may be true, eventually the system will want to adopt what works in their best interest, not necessarily the physicians' best interest, and the resources begin getting taken away. Anyone who wants to sell or be acquired has to be realistic about the fact that at the end of the day, it's a for-profit organization or private equity organization who has taken over the fiduciary responsibility for that company is to either create shareholder value or investor value. You would think the nonprofits would be behaving in a different manner just because their mission statements are different, but I think what we have discovered across the board is nonprofits are behaving in a similar manner. They're just tax exempt. So the way I look at it is that every player's the same, they just have different labels.

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