Why don't private practice physicians have more power in healthcare?

Private practice physicians are struggling as the physician workforce increasingly migrates to employed models. 

Six physicians joined Becker's to discuss why private practice physicians do not have more power in healthcare. 

Editor's note: These responses were edited lightly for clarity and brevity. 

Question: Why don't private practice physicians have more power in healthcare?

Tirun Gopal, MD. OB-GYN in San Francisco: 

It is becoming increasingly difficult for private practice physicians to devote any time to anything other than the practice of medicine, what with the diminishing compensation for services, time spent in keeping up to date with recent developments and the administrative time spent on maintaining a place of business. Nor is it easy for them to acquire the qualifications and skills needed for administrative work, including MBA, MPH, etc.

Furthermore, we have relinquished our control of the environment in which we practice (such as hospitals) to people who are either not physicians or physicians who have given up the practice of medicine, realizing that it is far more lucrative to lead physicians than to be one. The tables have hence turned. We allow these leaders, who do not bring a single penny to the organization, to tell us how to practice medicine, how much they will pay us, while they are laughing all the way to the bank with their unconscionable compensations. 

Helga Komen, MD. Assistant Professor of Anesthesiology at Washington University (St. Louis): Because traditionally they've been more oriented on profits than anything else.

Dan McGuire, MD. Gastroenterologist in Boynton Beach, Fla.: Too fragmented. What large hospital chain or insurance company cares about a few physicians?

Taif Mukhdomi, MD. Interventional Pain Physician at Pain Zero (New Albany, Ohio): Healthcare has become increasingly regulated over the past decade. Long gone are the days when physicians could decide to hang a shingle and announce to the community that they were open. To open a practice nowadays requires legal consultation, registration with medical and pharmacy boards, and often includes asking permission from officials, insurance companies and hospital systems to start taking care of patients. Newly trained physicians have spent the past decade of training learning how to treat patients and have not been educated about the healthcare system. The additional frustration is competing with hospital systems leveraging hundreds of physicians to further the company while private practices tend to be smaller in size. Private practice physicians will struggle to hold as much power as these systems unless there is a shift within the healthcare system towards leveling the playing field.

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. 

Matthew Smith, MD. Director of Neurocritical Care at West Virginia University (Morgantown): The biggest issue is the lack of collective bargaining for individual providers.

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