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I've lost autonomy in my corporate practice. Now what?

MDlinx Dec 09, 2023

The COVID-19 pandemic was the last time I practiced bedside medicine full-time. The moral injury from the pandemic drained me to my core, and when I asked my employers for a leave of absence so I could take care of my mental health, they told me no—so I quit. 

I had signed a non-compete and a 1-year contract, but it didn’t matter. Because I wasn’t just quitting the company—I was going to quit bedside medicine altogether. 


The corporatization of US healthcare


I was tired of being micromanaged by an administration that had never attended medical school. I had only a tiny selection of specialists to whom I was allowed to refer, and I was constantly incentivized to order tests and imaging studies that were not necessary. 

I felt like I was a corporate cog, something I never imagined for myself when I was in medical school. However, practicing medicine today means you are part of the corporate machine, as giant, private equity firms have stake in nearly every facet of medicine.

It's difficult to keep track of which monster health insurance company owns which medical practice, and which independent retail chains and drugstores are being bought out by which retail and pharmacy services giant. Insurer-owned clinics are purchasing physician groups and hospitals rapidly, controlling both care delivery and its payment. 


Private equity firms are no different, and they have drastically changed what it means to be a doctor. Physician-owned practices are becoming increasingly rare, as more and more doctors become employees of someone else’s company. These firms are purchasing rural hospitals, physicians' practices, nursing homes and hospice centers, air ambulance companies, and healthcare billing management and debt collection systems at a rapid clip. 

Private equity firms are also buying out healthcare staffing firms.

Fewer physicians are owners of the practice or hold equity in a practice or hospital, and instead are employees, meaning they are losing their autonomy.


More physicians are employees than ever before


According to a survey by the AMA, 2016 was the first year in which less than half of all practicing physicians had an ownership stake in their practice, noting that 2018 marked an unprecedented milestone: “[The] first year in which there were fewer physician owners (45.9 percent) than employees (47.4 percent).”

Kane CK. Policy Research Perspectives: Updated Data on Physician Practice Arrangements: For the First Time, Fewer Physicians are Owners Than Employees. AMA. 2019. 


In contrast, in 1988, 72.1% of medical practices were owned by physicians.

“The number one reason that physicians sell their practices to hospitals and health systems is related to payment concerns,” notes a news release from MedCity News.

Adams K. Fewer physicians are practice owners than ever & Medicare rates are to blame, AMA says. MedCity News. July 18, 2023.

“A full 80% of physicians surveyed by the AMA said that the ability to negotiate higher payment rates with insurance companies was a crucial factor that influenced their decision to sell their practice.”


The need to “efficiently handle the regulatory and administrative requirements imposed by payers, as well as to improve access to expensive resources,” were other factors named for why more and more physicians are selling their practices to corporations.


Pros and cons of corporate medicine


Working in a practice or hospital that is owned by a giant corporation most likely means that you are not calling the shots.

You may find yourself inundated with administrative tasks and electronic charts, while ordering more tests and imaging studies than if you were the sole decision maker. You may also find that you can only refer to certain specialists within your corporate network. You may take on more shifts due to staffing shortages without any additional compensation. 


But, with the loss of your autonomy comes a steady paycheck (even if you are underpaid). You may not find yourself losing sleep over worrying about the business side of medicine—something you never even learned in medical school. So, there are some benefits to be found in working in the corporate world.


What can you do if you feel yourself losing autonomy?


At the end of the day, you may feel like you are stuck running on a hamster wheel. 


The 'art' of medicine has lost its magic, and your skills are becoming hampered. It can feel suffocating.

The reality is that most physician employment opportunities mean being someone else’s employee, and having an ownership stake in your practice is becoming a thing of the past.

But, here’s some advice I can give if you want to resist:

  • Incorporate yourself and work for a physician staffing company, aka locum tenens.

  • Work only part time to improve your work/life balance.

  • Shift into a different aspect of medicine, such as academics.

  • Change career paths and exit clinical medicine, but use your knowledge and experience to work as a consultant or expert across various fields. 

  • Join a physician-owned practice or hospital (you most likely will still be an employee, but not in a huge corporate setting). 

  • Work for a nonprofit, such as Doctors Without Borders.

  • Transition into concierge medicine.

If you’re feeling suffocated by the corporatization of medicine, but feel like you have no choice, try to change your mindset—think about why you went into medicine in the first place, and focus on how you are making your patient’s lives better. You can also attempt to renegotiate your contract, set strict boundaries, strive for more equitable compensation, and insist on policies to improve your work-life balance.

Each week in our "Real Talk" series, mental health advocate Kristen Fuller, MD, shares straight talk about situations that affect the mental and emotional health of today's healthcare providers. Each column offers key insights to help you navigate these challenging experiences. We invite you to submit a topic you'd like to see covered.



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