I am old enough to remember our longtime family physician making house calls. He knew every member of my family, and was a trusted adviser.
Thanks to the government, few patients can expect to have that kind of long-term relationship with a physician anymore. Soon, most care will be administered by teams of providers with no one doctor continuously responsible for a patient’s well-being.
Physicians in solo or small-group private practice are being replaced by large-group practices that are increasingly affiliating with or owned by hospitals. From 2004 to 2011, hospital ownership of physician practices increased from 24 percent to 49 percent. Just 39 percent of doctors can now be considered old-fashioned family doctors.
The primary reason for this shift is physicians’ anxiety over compliance with expensive and burdensome government regulations, mandates, and reporting requirements. Young doctors overwhelmingly think in terms of becoming an employee rather than an independent practitioner.
Hospitals are buying up practices in order to “capture” their patients and control the services that their new physician employees provide. The Affordable Care Act (ACA) has accelerated this change by discouraging the traditional model of physician-owned practice and promoting the formation of Accountable Care Organizations (ACOs)—combinations of multiple healthcare providers.
