Does non-physician practice ownership reduce the quality of patient care?

This article first appeared on our sister site Medical Economics.

Findings from a recent survey reveal that among physicians practicing under non-physician ownership, nearly 60% believe it lowers the quality of patient care.

The survey showed that employed physicians feel their clinical autonomy is compromised under corporate ownership.

The survey, which was completed by 1000 employed US physicians, highlights the challenges and opportunities physicians encounter in hospital and corporate-owned settings. It was commissioned by the Physicians Advocacy Institute and conducted by NORC at the University of Chicago.

Questions on the survey delved into the experiences of physicians employed by hospitals, health systems, venture capital and private equity firms, health insurance companies, and staffing agencies. The results provide insight into the implications of the significant increase in corporate ownership of physician practices over the last decade.

A critical concern voiced by physicians is the perceived negative impact on the physician-patient relationship. Many respondents cited decreased time with patients and a heightened focus on financial success as factors contributing to a decline in the quality of care. Only 18% of physicians felt that the growth in corporate ownership of medical practices has improved care quality, pointing to increased investment in infrastructure and technology as well as a focus on patient-centered outcomes as the primary benefits.

Kelly Kenney, CEO of PAI, expressed concern over the shift in priorities that comes with corporate ownership, stating: "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."

The survey showed that employed physicians feel their clinical autonomy is compromised under corporate ownership. Three in five physicians (61%) reported having moderate or no autonomy to make referrals outside of their practice or ownership system, and nearly half (47%) reported policies or financial incentives to adjust patients' treatment options to reduce costs.

Physicians expressed frustration about limited input on practice management policies and decisions, burdensome electronic health record processes, and challenges in hiring and administrative support. The study found 60% of respondents were required to sign a "non-compete" agreement limiting their ability to practice locally if they leave their employment, and 44% indicated they would consider joining a trade union if it were an option.

While more than half of physicians (55%) who transitioned from private practice to employment reported satisfaction with their decision, concerns about the erosion of the physician-patient relationship and autonomy persist.