In recent years, we have seen a growing trend of large corporations acquiring primary care clinics. Earlier this month, the New York Times published an article entitled "Corporate Giants Buy Up Primary Care Practices at Rapid Pace."
While the title may accurately capture the pattern at the surface level, the article does not provide the full context and nuance needed to deeply understand this trend and its implications. Health plans, private equity firms, and retailers are absolutely racing to buy up physician practices. But the rise in ownership isn't a guaranteed success — nor is it a guaranteed failure for the industry.
Below are the five misconceptions from the article — and how we want health leaders to shift their thinking (as well as their next steps):
Overall, the tone of the Times article is that primary care has a "lowly status," stating that it doesn't make sense for corporate owners to have their eye on such an unglamorous profession. However, corporate owners are not blind to the importance of primary care providers (PCPs). They are betting they can transition to value-based care (VBC) — and make money on it — which is impossible without primary care.
Health systems and medical groups have long seen the power of primary care — though their legacy appeal may have been more for network integrity than succeeding in alternative payment models.
Now, nearly every player in healthcare has their sights on primary care — because PCPs are not just a means to acquire patients, they are powerful actors with the ability to manage utilization, make referrals, control where patients get care, and more. And their relative power becomes even more important in VBC business models. This is exactly why we see so much attention on owning and acquiring primary care practices today.
While the industry is betting on the power of primary care, physicians themselves would no doubt say that their employer underestimates their value (and maybe, their paycheck). Those who employ PCPs should provide the tools, resources, leadership, and compensation that matches their overall value — or risk losing them to a competitor, including corporate owners.
Problems like burnout, administrative burden, and undervalued primary care are longstanding, deeply rooted issues. They are systemic to the practice of medicine — not a result of increased corporate ownership alone.
In fact, it may be that the rise in corporate ownership alleviates some of these issues. Because these models are focused on succeeding in VBC — and because these capital-rich partners have more resources to offer, corporate owners may be more able to integrate their providers into a seamless technology platform, give them additional resources to reduce the administrative burden of medicine, and implement a holistic care team approach, while promising to uphold physician autonomy. While these are all things providers desperately want, the status quo model doesn't necessarily provide them.
We're waiting to see if these corporate owners actually follow through on their promise to physicians as they navigate the difficult task of integrating an entire ecosystem towards a common purpose —succeeding in VBC.
Ultimately, all physician employers must invest in tools that make the job of practicing medicine more sustainable while maximizing efficiency. The players that do this successfully stand to win the most talent — irrespective of ownership.
Current evidence does not indicate that ownership models inherently change doctor-patient relationships. Just like with burnout, the more important factors to look at are the tools, resources, and standards that owners integrate into all their practices that may support or erode these relationships.
If executed correctly, the capital that comes from corporate ownership can be used to acquire tools that actually strengthen the relationship. For example, a larger care team and technology that can mine data in the EHR to personalize interactions.
Corporate owners have their eyes set on primary care precisely because they view it as the entry point to then steer patients to other services within their ecosystem, making the doctor-patient relationship even more paramount. Is this another false promise? We're watching to see how this plays out.
All leaders should invest in the tools and structures that enable deeper relationships with patients and any member of the care team. This can include reducing the administrative burden of medicine, investing in solutions that address care holistically, and anticipating future care needs.
The Times article alleges that "many doctors are becoming mere employees and losing their autonomy."
As the arms race for physician talent continues, employers of all kinds are winning physician acquisition by offering autonomy. And there are multiple dimensions of autonomy — clinical autonomy (I can practice the way I want), schedule autonomy (I can control the pace of my schedule), and strategic autonomy (I have a role in decision making).
Keep in mind that giving up some level of autonomy is necessary in all clinical practice. Especially with the move to value-based care, there's a greater need for clinical standards and maintaining patient access. The important thing to remember is that many new corporate owners are trading on the promise of more autonomy in other areas like offering part-time options.
Current and future employers should reevaluate the kinds of autonomy they offer. Everyone must get more specific in their conversations on autonomy and recognize that tradeoffs are inevitable — anything otherwise is an empty promise.
Public discourse on physician acquisition negatively links two interdependent things: corporate changes and care delivery changes. It presupposes that physician practice independence is the only way to safeguard care delivery.
The principled way to start thinking about PCP acquisition is asking "what does good care delivery look like" and then asking if corporate ownership changes that. And if it does, is the change for the better or for the worse?
Our biggest take away for health leaders is not to conflate ownership with the structural challenges in healthcare. If we want to move to a world where VBC is more than an exception, if want to solve the root causes of burnout, if we want to reduce turnover for all members of the care team, and if we want strong patient-doctor relationships, health leaders must invest in solutions that enable the best care for patients and the best environment for doctors (regardless of who is signing their checks).
Ultimately, we agree with the Times' claim that "it may be too soon to determine whether consolidated care will improve patients' health." But rather than defaulting to the idea that consolidation will make things worse, we need to look at the full context before passing judgement.
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