In earlier blog posts we have discussed the consolidation of hospitals. In Washington, for example, there are now six major hospital “chains” in the state. Recently, Virginia Mason entered into a form of partnership with Catholic Health Initiatives, one of the major Catholic hospital chains in the U.S. As a result, the number of medical private practices continue to shrink.
A parallel trend has been the shrinking of private medical practices. How much of that is linked to the hospital consolidations isn’t clear, but hospitals and larger hospital chains now directly employ a majority of all practicing physicians.
For those of us over the age of 50, “seeing the doctor” usually meant going to an office that had fewer than ten physicians, either practicing individually or as a small specialist medical group. In recent times, it has often meant going to a hospital with adjacent medical offices where the doctor is directly employed by the hospital
A recent survey by the American Medical Association (AMA) collected data showing a significant decrease from 2018-2020 in the number of physicians working in private, physician-owned practices. “The shift away from private practice setting has been in evidence for several years, but the magnitude of decline from 2018-2020 suggested the shift toward larger, non phyisician-owned practices has increased.”
The reasons are likely varied. Certainly, the economies of scale means the cost of maintaining a practice is less in larger settings. Avoidance of being on “call” for non-daytime care may also be a factor. Most doctors say that giving up one’s independence also means shifting a lot of administrative work to others, such as billing and record-keeping.
It is also possible that the COVID shut-downs also was a factor, since smaller independent practices found their patient numbers sharply reduced. The survey study noted that “patient practices were hit hard by the economic impact of the early pandemic as patient volume and revenues shrank while medical supply expenses spiked.”
Whatever the reasons, the practice of medicine is much more a business model than it used to be. Whether that is a change for the better may not be clear for many years.
