For many physicians, weighing the scales of independence and employment comes down to leverage.
According to a 2023 analysis by the American Medical Association about physician employment status, many physicians have left independent practice to gain better bargaining power with payers, as larger health systems and hospitals typically have better leverage than smaller, independent practices.
"The AMA analysis shows that the shift away from independent practices is emblematic of the fiscal uncertainty and economic stress many physicians face due to statutory payment cuts in Medicare, rising practice costs, and intrusive administrative burdens," AMA President Jesse Ehrenfeld, MD, said in a 2023 article on the organization's website.
For some, the push toward consolidation is among the biggest concerns for physicians overall.
"On the whole, the biggest threat to physicians in 2024 is consolidation and integration with private equity, employed relationships and being out leveraged by the payer community," Ben Mandelbaum, MD, an orthopedic surgery professor at Cedars-Sinai in Los Angeles, told Becker's.
For those seeking to remain independent, the lack of leverage could mean turning away from payers that will not meet rates physicians see as fair.
"From a reimbursement standpoint, inflation has been everywhere from salaries, cost of goods and construction," Nitin Khanna, MD, a surgeon at Munster, Ind.-based Spine Care Specialists, told Becker's. "Government has decided to decrease Medicare reimbursement somehow. Physicians will need to be able to negotiate their rates at a society level to give leverage or simply drop out of insurance that refuses to pay a fair rate."