Physicians Increasingly Losing Control of Medicine
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 the number was 60%. 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 that are 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.
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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.