The traditional medical practice model of the independent physician owning and operating his or her own practice is nearly gone. Once upon a time, you found a primary care physician or specialist that you liked and trusted and stuck with them. They were there for you when you needed them and, over time, grew to know you well.

In the corporate model, a large hospital system or for-profit corporation buys out many individual practices and turns physicians into employees. The focus becomes profit and productivity. Lip service is paid to quality by tracking such things as Press Ganey scores, which only track patient satisfaction, not quality of care, and have been shown to be notoriously unreliable because they often rely on things over which a physician has no control. Employed physicians must meet metrics established by the corporation- how many patients they see per day, how many tests are ordered, how many procedures are done, etc. Salaries and bonuses are predicated on meeting these metrics.

The corporate model has replaced the physician/owner with a generic “provider” which can be replaced anytime, sometimes with a non-physician surrogate, such as a nurse practitioner or physician’s assistant. One primary care family physician with forty years of practice experience recently announced his retirement. The medical director of the large physicians group that employed him asked him if he would train his replacement, a physician’s assistant. The education and clinical experience of a physician’s assistant is a fraction of that received by even a 4th year medical student, and the medical student must go on to complete an accredited residency training program in a specialty of medicine ranging from three to seven years to become board certified. The physician’s response was short and succinct. He said, “Hell, no!”

That this was even considered showed how skewed the priorities have become. There is only one reason why a physician’s assistant would be seen as an appropriate replacement for a physician: you can pay them less.

Young physicians seem to have accepted the shift to corporate medicine versus traditional practice. Indeed, they seem to be driving it. Rather than seek to establish themselves in a stable, long-term practice in a community, where they will have a sense of ownership over the practice and their patients, they prefer to be employees, with regular hours, little to no emergency responsibilities after hours and on weekends, a regular paycheck, 401K plan, dental and medical plan, paid malpractice premiums, and paid vacations. These are things independent doctors have to provide for themselves.

Once upon a time, an established doctor brought a young associate into the practice. The young associate established themselves over time, bought into the practice, and eventually, the older doctor would ease out and turn over the practice to his younger associate. The cycle would then repeat. No longer. Independent physicians find that they cannot attract younger associates. In addition to the above perks, most want a guaranteed income that is often more than the established physician has ever earned. Such incomes can be offered by corporations that have a greater profit margin and work on scale. Is it any wonder that independent medical practice is becoming a thing of the past?  

Richard T. Bosshardt, MD, FACS