Source: Physicians Advocacy Institute 

Survey of 1,000 employed U.S. physicians reveals challenges and opportunities of practicing in hospital and other corporate owned settings

Almost 60% of physicians who practice as employees of hospitals and other corporate entities say that non-physician practice ownership results in a lower quality of patient care, according to a comprehensive survey by NORC at the University of Chicago. The survey, commissioned by the Physicians Advocacy Institute (PAI), examines the experiences of physicians employed by hospitals and health systems, venture capital and private equity firms, health insurance companies and staffing agencies.

Most physicians surveyed cited decreased time with patients and greater focus on financial success as factors negatively affecting quality at non-physician-owned medical practices. Only 18% of respondents felt that the growth in corporate ownership of medical practices has improved care quality. These physicians cite greater investment in infrastructure and technology and increased focus on patient- centered outcomes as key benefits of corporate ownership.

The survey provides key insights into the implications of the last decade’s dramatic increase in corporations owning physician practices for both patients and physicians.

“The patient-physician relationship is the foundation of our health care system,” said Kelly Kenney, chief executive officer of PAI. With corporate ownership comes a higher emphasis on financial outcomes and shareholder returns. This focus on the bottom line can interfere with best clinical practices.”

The survey demonstrates a belief among many employed physicians that corporate ownership may erode foundational aspects of the patient-physician relationship and impact patient outcomes. Employed physicians cite concerns about specific corporate owner policies that diminish their clinical autonomy, including three in five (61%) saying they have moderate or no autonomy to make referrals outside of their practice or ownership system and nearly half (47%) reporting policies or financial incentives to adjust patients’ treatment options to reduce costs, including lower cost drug therapies (45%). Seventy percent of physicians say their employer uses incentives and/or penalties to have physicians see more patients per day.

Physicians who moved from private practice to employment did so to achieve a better work-life balance and increased compensation, with declining government reimbursement and private insurers’ payment and contracting policies cited as key factors. More than half (55%) of these physicians report continued satisfaction with their decision to leave private practice.

The survey also reveals insights into how corporate ownership impacts non-clinical aspects of physicians’ professional lives. Physicians expressed frustration around having minimal input on practice management policies and decisions, burdensome electronic health record processes and issues of hiring and administrative support. Sixty percent of physician respondents were required to sign a “non-compete” agreement limiting their ability to practice locally if they leave their employment, and 44% indicated they would consider joining a trade union if it were an option.