The erosion of physician autonomy 

Autonomy is on many physicians' minds as the workforce becomes increasingly consolidated and the number of employed physicians grows. 

Around 108,700 physicians left private practice for employment between 2019 and 2021, according to a report from Avalere. And in 2022, just 44% of physicians owned their practice, compared with 76% in the early 1980s, according to a report from the American Medical Association.

Declining reimbursements, skyrocketing operating costs and rising medical debt are just a few of the reasons physicians are finding it harder to remain independent. 

Leaders are fearful of the loss of autonomy this shift is bringing to many physicians. Fifty-six percent of employed physicians said what they like least about their job is less autonomy, according to the Medscape's "Employed Physicians Report 2023," a jump from 48% the previous year

Many employed physicians believe corporate ownership lessens their clinical autonomy. Around 61% of employed physicians said they have moderate or no autonomy to make referrals outside of their practice or ownership system, and 47% said they adjust patients' treatment options to reduce costs based on practice policies or incentives, according to a survey from NORC at the University of Chicago. 

"This one factor makes physicians vulnerable to the whims of large corporations," Loay Kabbani, MD, a vascular surgery specialist at Detroit-based Henry Ford Health, told Becker's. "As physicians become more and more employed, we lose control of our practice and our patient-physician relationships."

Many leaders feel the loss of autonomy is the biggest threat to physicians. Cary Passik, MD, chief of cardiothoracic surgery at Suffern, N.Y.-based Good Samaritan Hospital, told Becker's the erosion of autonomy is also affecting patient-physician relationships because "the administrative burdens of being a physician have become so onerous."

Many physicians say they are losing their ability to influence how patient care is delivered — 60% of physicians said non-physician ownership of practices results in a lower quality of patient care, according to the NORC survey. 

"I hear from physicians all the time about how they no longer have little if any input in their patients' care," Harry Severance, MD, an adjunct assistant professor at Durham, N.C.-based Duke University School of Medicine, told Becker's. "Instead, a business manager comes in and tells them, we need to increase profits, so you need to see more patients per hour, increase your billings, make more in-house referrals, keep your patient satisfaction scores up, don't report violent patients, etc."

Physicians cited decreased time with patients and a greater focus on financial success as the biggest issues affecting the quality of corporate-owned practices. 


But in private practice, many physicians have more freedom to provide personalized care to patients. 

"I have this flexibility to do what I think is right," Calvin Wong, MD, a cardiologist at Pacific Cardiology in Honolulu, told Becker's. "I'm not obligated to send the patient to the hospital that employs me. I can send who I think is the best doctor for that particular patient … so therefore it's a question of patient fit. The cornerstone of independent practice is the doctor-patient relationship. In Hawaii, which is very multicultural, if I have a Chinese-speaking patient from China, I'm gonna send him to this Chinese-speaking doctor in Chinatown. I can match the patient to the background."

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