PAI Research

Physicians Advocacy Institute

The Impact of Practice Acquisitions and Employment on Physician Experience and Care Delivery

For over a decade, there has been a sustained trend of physicians leaving private practice for employment by corporate-owned practices, often affiliated with hospitals, health systems, health insurers and private equity firms.

PAI commissioned NORC conducted a survey of one thousand employed physicians to gain insights into the implications of this trend on care delivery, clinical decision making, physician practice administration and professional satisfaction.

Key Findings

Over half of employed physicians reported that changes in practice ownership reduced the quality of patient care, citing an erosion in clinical autonomy and a greater focus on financial incentives. Almost half of physicians reported a deterioration in relationship with patients, seen mainly in decreased visit time and communication. For physicians who shifted from independent medical practices, various factors including government and private insurer payment cuts, drove their decisions.

Physicians report concerning trends in care delivery, indicating reduced autonomy, strained patient relationships, and diminished communication due to ownership changes

  • Almost 60% of physicians reported that reduced autonomy was one of the top negative impacts of ownership changes on patient care quality
  • Nearly half of physicians (45%) reported that ownership changes worsened their relationships with patients
  • Decreased time and communication were reported (80%) as top negative impacts of ownership changes on the physician-patient relationship

Physician responses underscore the complexities involved in making clinical decisions for their patients, including employers’ policies that influence these decisions

  • 56% of respondents said that cost of care to the patient has some impact on their clinical decision-making
  • 47% of respondents said that practice policies or incentives led them to adjust treatment options to reduce costs
  • 37% of physicians report moderate or low autonomy in making clinical decisions
  • 61% of respondents have moderate or low autonomy to refer patients outside of their ownership structure/ system
  • 70% of respondents report employer uses incentives for physicians to see more patients
  • 45% of physicians reported policies that influence or limit their decision-making on drug therapies for patients

Two-thirds of physicians' report having little or no involvement in practice management policies

  • Over 40% of physician respondents expressed dissatisfaction with workforce-related issues including hiring, staff management, and administrative support
  • Respondents expressed high satisfaction with medical equipment (53%), technology training (36%), and the quality of technology/EHRS policies and procedures (37%) at their current practice
  • Interestingly, more than half (52%) of respondents lacked awareness of a formal process to resolve disputes at their workplace

Physicians who moved from independent practice to employment cited a myriad of factors that influenced their decisions with work-life balance and compensation ranking the highest

  • Government and private insurer reimbursement cuts were driving factors in choosing employed positions for over half of physicians who responded to the survey (both 53%)
  • 60% of respondents stated that they their current employer required them to sign a non-compete agreement
  • Frustrations with current employment are reflected in the 44% of respondents who said they would join a union if available and amongst the compelling reasons they cite for wanting to retire early – burnout (74%) ranking the highest

Full report
Key findings