Care Quality, Physician Autonomy Lower at Corporate-Owned Practices

Changes in physician practice ownership resulted in lower patient care quality and poorer patient-provider relationships, according to a survey from NORC at the University of Chicago, commissioned by the Physicians Advocacy Institute.

NORC researchers surveyed 1,000 physicians employed by a hospital or health system, venture capital or private equity firm, health insurance company or subsidiary, or staffing agency from July 17 to August 7, 2023, to assess how ownership changes impacted their experiences.

Non-physician practice ownership negatively affects care delivery, respondents indicated. Most physicians in hospitals (59 percent), venture capital or private equity firms (60 percent), and staffing agencies (75 percent) reported reduced patient care quality following ownership changes. Meanwhile, just 18 percent said ownership changes improved care quality.

Nearly 60 percent of physicians cited reduced autonomy as one of the top adverse impacts of ownership changes on patient care quality. Almost half (45 percent) of physicians reported that ownership changes worsened their relationships with patients.

Patient-provider relationships deteriorated mainly due to decreased time and communication, according to 80 percent of physicians. Physicians also cited deprioritized patient needs and preferences, limited patient choice and autonomy, and fragmented care coordination as issues stemming from ownership changes that hurt patient-provider relationships.

“The patient-physician relationship is the foundation of our health care system,” Kelly Kenney, chief executive officer of Physicians Advocacy Institute, said in a press release. “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.”

Physicians also reported experiencing challenges and barriers to clinical decision-making. For example, 56 percent of respondents said that the cost of care to the patient impacts their clinical decision-making. Physicians reported moderate or low autonomy in making clinical decisions (37 percent) and referring patients outside their health system or ownership structure (61 percent).

Forty-seven percent of physicians noted that practice policies or incentives led them to adjust treatment options to reduce costs, while 45 percent reported policies that influence or limit their decision-making on drug therapies for patients.

Seven in ten respondents said their employer uses incentives for physicians to see more patients, 35 percent of whom indicated positive incentives, 8 percent cited negative incentives, and 27 percent noted both positive and negative incentives.

Physicians generally do not have a say in administrative decisions in non-physician-owned practices, with 67 percent reporting little or no involvement in practice management policies. A little over half (52 percent) of physicians said they were unaware of a formal process to resolve disputes at their workplace.

Over 40 percent of respondents were dissatisfied with workforce-related issues, including hiring, staff management, and administrative support.

However, physicians were satisfied with medical equipment (53 percent), technology training (36 percent), and the quality of technology and EHR policies (37 percent) at their practice.

Physicians left private practices for employed positions for better work-life balance, higher pay, and malpractice insurance. Declining reimbursement from government programs and private payers was a driving factor for 53 percent of physicians who left private practices.

Sixty percent of physicians said their employer required them to sign a non-compete agreement, and 44 percent indicated they would join a union if available. Despite these challenges, 55 percent of physicians reported being satisfied with their decision to move to an employed position.

“As the structure of medical practice fundamentally changes, health care leaders and policymakers have a responsibility to make sure patients and their physicians remain at the center of health care,” Kenney said. “New insights on the employed physician landscape can shape crucial policy decisions in the future.”