CEO, Atlas Surgical Group, one of the largest private ASC groups in the U.S., Author of “Success in Ambulatory Surgery Centers.”
The healthcare landscape has significantly changed in recent years, particularly regarding the dynamics between doctors and big hospitals. One aspect that deserves attention is the reluctance of doctors to unionize and stand up against the growing influence of these institutions.
Private practice, once a cornerstone of the medical profession, is facing a gradual decline. This decline can be attributed to various factors, including the rise of corporate healthcare entities, complex regulatory frameworks and declining reimbursement rates. However, I believe the lack of collective bargaining power among doctors exacerbates these challenges. This is where unionization could be an important tool.
Unionization empowers individuals to collectively negotiate better working conditions, fair compensation and greater control over their professional lives. Unfortunately, the medical profession has seen limited progress in this regard. Driven by a deeply ingrained culture of autonomy and individualism, many doctors remain hesitant to join unions or professional organizations that advocate for their rights.
The Power Imbalance’s Impact On Private Practice
• Dominance Of Large Healthcare Systems
The reluctance of doctors to stand up against big hospitals has helped perpetuate a power imbalance that is detrimental to private practice. Fueled by their financial and administrative might, hospitals negotiate contracts with insurance companies that favor larger healthcare systems. Numerous studies have indicated a rise in hospital consolidation, leading to increased market concentration and reduced competition. A report published by the Health Affairs journal showed a rise in the Herfindahl-Hirschman Index (HHI)—a measure of market concentration—for hospitals between 2010 and 2016, indicating a decline in competition within the hospital market.
• Financial Strain On Private Practice
The power imbalance has also contributed to the financial strain on private practitioners. Hospitals’ dominance enables them to negotiate higher reimbursement rates, leaving private practitioners at a disadvantage. The American Medical Association (AMA) reported that in 2020, a majority of physicians were working outside of physician-owned practices. “This is the first time the share of physicians in private practices has dropped below 50% since the AMA analysis began in 2012.”
• Quality Of Patient Care
The erosion of private practice not only impacts doctors but also has implications for patient care. Private practitioners often have more personal connections with their patients, fostering trust, continuity of care and individualized attention. As big hospitals expand, patients may experience fragmented care, longer wait times and reduced access to personalized medical services.
The Call For Collective Action
To reverse the decline of private practice, I believe doctors must recognize the urgent need for collective action. By joining forces through professional associations or unions, doctors can increase their bargaining power, advocate for fair reimbursement rates and protect the integrity of private practice. United, doctors can more effectively engage in negotiations with insurance companies and hospitals, working toward a more balanced healthcare system.
Pulling from my own experience as the CEO of a multispecialty group, I feel that the strongest impetus for bargaining comes from collaboration at the grassroots level. Physicians should start by joining forces at all levels of practice, be it private hospitals or academia. As Aesop said, in union there is strength. Call upon your own strength to be heard. Fear of retribution dilutes as your numbers increase. One is a target. Two is a team. Three is a force.
Labor laws traditionally dissuade physicians from unionizing because they are considered part of management. The good news (or bad news, depending on how you view this) is that in employed positions, physicians are not management—they are typically treated more like worker bees, easy to dispose of. Right there is the carte blanche to form their own collaborations.
Successful Examples Of Collective Advocacy
There have been several instances where doctors’ collective advocacy has yielded positive outcomes. For instance, the Physicians Advocacy Institute, a coalition of state medical societies, successfully lobbied for changes to Medicare’s Quality Payment Program in 2019, alleviating some administrative burdens on small practices. More recently, residents have been voting to unionize at Mass General Brigham Hospital, with 75% of the trainees being for unionization. This should greatly increase their negotiating power. Such examples demonstrate the potential impact of organized efforts in reshaping policies and creating a more favorable environment for private practitioners.
The decline of private practice is a complex issue influenced by various factors, including doctors’ reluctance to unionize and stand up against big hospitals. By embracing collective action, I believe doctors can regain their influence and advocate for fair compensation, improved working conditions and the preservation of private practice. In this way, the challenges facing private practitioners can be faced with a united front that can empower doctors to shape the future of healthcare and ensure the continuation of personalized, patient-centered care.
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