Physicians Increasingly Losing Control of Medicine
by
Julio Gonzalez, M.D., J.D.
What is likely the most
significant development in healthcare is also one that most will not see
reported. A survey from the American Medical Association has found, for the
first time, that the majority of physicians in the United States work outside physician-owned
practices. According to the AMA,
only 49.1% of doctors work in physician-owned practices, a drop of 5 percentage
points from the prior survey performed in 2018 and an 11% drop from 2012 when
60% of physicians worked in physician-owned practices. The egress was mostly towards hospital-controlled
practices or direct hospital employment, which now comprise 40% of physicians'
practices.
Interestingly, there is a
new addition to physician employment: practice ownership by private equity firms. In a survey choice the AMA had not
previously offered, 4% of physicians indicated they worked in a practice owned
by a private equity firm. In 2018,
although the choice was not directly offered, the relationship was identified
amongst 2% of the responders who marked "other" and then wrote
"private equity firm" as their employer.
The trend is significant
beyond the obvious implication of who controls a person's healthcare. When physicians were the primary owner
of medical practices, the relationship between patients and their doctors
tended to be more intimate and personal.
There was much less room for intervention by administrators and CFOs
whose primary interest was the company's bottom line. Additionally, when the physician owned
the practice, there was no doubt as to where the decision-making buck
stopped. Now, there are many more
hidden layers to healthcare, such as corporate interests and the zeal with
which hospitals rush to comply with regulatory requirements.
But below the surface
there is perhaps a much more pernicious force. Medicine's professional organizations
such as the AMA (the ones supposed to represent the practice of medicine) have
increasingly been undermined by interests outside of science and patient
advocacy. Rather, because its
members are increasingly employed by corporations and non-healthcare providers,
their positions on healthcare increasingly representing the hospital and the
corporation. The overall pressure
is to place healthcare decisions further away from the patients' hands and
nestle them within those of the hospitals.
Dr. Jane Orient, the
Executive Director of the Association of American Physicians and Surgeons observes, "The corporate practice of medicine has long
been considered unethical and illegal."
Today, it is increasingly
in danger of becoming the norm.
This article brought to you compliments of Dr. Julio Gonzalez
and thefederalistpages.com.
Dr. Julio Gonzalez is an orthopaedic
surgeon and lawyer living in Venice, Florida. He served in the
Florida House of Representatives. He is the author of numerous books
including The Federalist Pages, The Case for Free Market Healthcare,
and Coronalessons. He
is available for appearances and book signings, and can be reached
through www.thefederalistpages.com.
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