Medical Practice Evolution

I entered medical school in 1975. A lot has changed in the world since then, especially in the field of medicine.

We have technology today that was unthinkable in 1975.  Most surgery today is done through small incisions through the use of endoscopic equipment that allows surgeons to see inside the body through sophisticated cameras rather than through direct visualization. This has greatly shortened healing times for all kinds of surgery.

We have diagnostic equipment unheard of in 1975 – especially magnetic resonance imaging (MRI scanners) that make it possible for us to detect pathology much earlier and more accurately than we ever dreamed of before. Every field of medicine has improved in its ability to diagnose and treat disease.

What hasn’t improved, however, is the practice environment for physicians. I’m talking about the place where they go to work and their autonomy in making decisions about their patients. That has gotten worse.

When I began my orthopedic practice in 1984, about 3 of 4 physicians were in private practice. The rest were employees of hospitals or corporations, particularly in the specialties of radiology, pathology, anesthesiology and emergency medicine. Today those numbers have reversed – about 3 of 4 physicians are now working for hospitals or corporate entities.

Jared Dashevsky, writing for Workweek, says the percentage of hospital or corporate-employed physicians has increased 19% over the last three years, from 62% to 74%. This has likely been impacted by the Covid-19 pandemic, which placed great pressures on those in private practice. What’s particularly interesting is the difference between hospital and corporate entity acquisitions:

  • Hospitals acquired 4,800 physician practices since January 2019, a 9% increase.
  • Corporate entities, like PE firms or health insurers, acquired 31,300 physician practices since 2019, an 86% increase.


What is driving this change?

Pandemic pressures and the current labor and supply shortages have stressed physician practices both financially and mentally. Physician burnout has become a big problem with more and more physicians retiring early or finding alternative working environments. An acquisition is a quick and lucrative way for physicians to shift the responsibility of running a practice to someone else. These benefits include:

  • Financial risk protection
  • Less administrative burdens
  • Electronic Health Records (EHR) implementation
  • More routine scheduling


These benefits have driven many physicians into the arms of hospitals or corporate entities. However, there is a downside to these changes:

  • Decreased income
  • Decreased autonomy in decision-making
  • Profit-driven motives of their employers
  • Decreased flexibility of hours


Dr. Dashevsky believes the pendulum that has shifted from private practice to hospital/corporate practice will someday shift back. As physicians crave the autonomy they once had, or want to experience it for the first time, change is likely. Personally, I hope it does. There is nothing quite like knowing there is no one getting between your patient and you when it comes to deciding what’s best for your patient. That feeling is being lost, and the sooner it returns, the better for all patients.

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