What physician autonomy really looks like

Physician autonomy is becoming increasingly rare in the healthcare field, as the majority of doctors today are employed by hospitals and health systems. While they may not be told how to practice medicine, company leadership does instruct them on ways to improve efficiency, maximizing patient volume and profit.

Doctors value autonomy. The organizations that facilitate consolidation claim to, as well. The problem is that health systems and clinicians have different understandings of what autonomy is and should look like for doctors, and research shows that doctors’ definition is the one that leads to better outcomes for patients. 

How health systems define autonomy

Health systems tout efficient practices and claim to grant doctors greater autonomy because corporate leadership takes care of business operations, which in turn allows doctors to focus more on practicing medicine. But while doctors are typically most driven by patient outcomes, health systems care more about the bottom line. This has led to cost-cutting measures, such as replacing nurses with medical assistants, and investing in lower-quality equipment.

With consolidation, the systems that doctors work under don’t allow them to practice to their full potential — let alone autonomously.

A 2021 American Medical Association (AMA) report on high-performing physician-owned private practices asked doctors about their experiences remaining independent in the shadow of consolidation. For many, the ability to practice medicine in a way that works for them is paramount.

“The world of medicine now actually tells you what you have to do. It no longer accepts the idea that you’re a physician and you absolutely know what you’re doing,” said one AMA physician survey respondent, alluding to the importance of autonomy when creating treatment plans.

A physician from a small cardiology practice in the Northeast expressed a similar sentiment: “We can continue to do what we think is right and not necessarily what the hospital system feels is the way we should approach a problem… They have people making decisions that aren’t necessarily clinicians and telling you that they don’t have the money to support this program,” clarifying that health systems aren’t dictating every decision a doctor makes, but rather that being independent allows individual doctors to use their best judgment and tailor treatments to patients. 

For other doctors, autonomy means successfully balancing family with career success. A physician from a small general surgery practice in the Midwest shared that their practice “completely shifted [its] schedules to accommodate what [its doctors] needed to do for kid life.”

Embedding within a community and donating to charity are other facets of autonomy that larger systems don’t support. “If you want to support the local football team, you just write a check and support the local football team, or if you want to do free sports physicals, you just sort of do it,” said a physician from a solo primary care practice in the South, adding that the pride they feel in actively being involved in the community is a big motivator for them.

If doctors’ definitions of autonomy aren’t one-size-fits-all, why do big health systems shoehorn medical professionals into working in a one-size-fits-all way?

Clinician experiences under health systems

A 2020 survey of 799 physicians conducted by Athena Health found that more than 50% of respondents experienced organizational changes at their workplace, such as mergers, layoffs, and new EHR tools. These changes, which largely affected the way work happens in health systems, had ripple effects. Physicians who experienced a merger “reported feeling less positive about their collaboration with colleagues, less safe and supported, and less inspired to go above and beyond,” according to a TechTarget summary of the report.

Most respondents reported working extra hours at home to catch up on paperwork, and only 29% of doctors felt that their organization was equipped to handle administrative tasks. The operational changes that come alongside mergers and consolidation hurt healthcare providers.

A 2018 study published in the Journal of the American Board of Family Medicine found that doctors at small, independent primary care practices had lower rates of burnout relative to the national average. As outlined in a Fierce Healthcare summary of the research, doctors at independent practices reported a burnout rate of 13.5%, compared to the national average of 54.4%. Put simply, “the independence and sense of autonomy that providers have in these small practices may provide some protection against symptoms of burnout.”

Lead author and Professor of Population Health and Medicine at NYU Langone Health Donna Shelley, M.D., explained that doctors at independent practices have a greater sense of autonomy, have a say in the decision-making process, and can directly shape workplace culture. What’s more, the physicians Shelley spoke with said that their workplaces offer opportunities for growth, the ability to learn from mistakes, and to learn from each other.

Daniel E. Choi, M.D., a New York-based orthopedic spinal surgeon in private practice, told the American Medical Association, ”Independent practice puts medicine back into the hands of physicians. It gives us control over all aspects of decision-making of the patient's care [...] You're not sitting there doing conveyor-belt medicine, getting forced to see 30, 40, 50 patients a day and feeling like you have no control over your lifestyle and your hours.”

Clinical autonomy, then, doesn’t only affect how care is delivered. It can also shape doctors’ well-being and attitude toward their work.

How Meroka defines autonomy

“The system performs to my standards and lets me operate to my full potential.”

“I can see the patients I want to see.”

“This is why I got into the practice of medicine.”

“I don’t have to compromise between spending quality time with my family and providing quality care to my patients.”

These are just some of the comments we’ve heard from doctors about why an independent practice matters in healthcare.

At Meroka, we’re working to reverse the years-long trend toward consolidation by equipping physician-owners with resources and knowledge to keep their practices independent, even after they retire. We believe that autonomy is good for patients, good for doctors, good for the clinic bottom line, and good for the insurance providers, whether public or private.

Our definition of autonomy is one that gives doctors the freedom to practice in whatever way best suits them, their patients, and their local community. They set their hours, the number of patients they’ll see in a day, the staff they have to support and work alongside them, their treatment plans, their practice’s policies, and more. 

When medical professionals have the freedom to practice in a way that supports them as expert clinicians, they see better health outcomes across the board, and at lowered costs. 

“We actually, I think, have cheaper care and better outcomes, and our physician-owned hospitals show the same thing,” said a physician from a medium-sized general surgery practice in the Midwest in a 2021 AMA report. “We do cheaper surgery at our physician-owned hospital … with better outcomes. Our infection rate is way lower and … we are the only five-star hospital in the state year after year.”

And this isn’t specific to healthcare. Research has shown that employee-owned businesses outperform their counterparts in job retention, pay, staff retirement savings, and more. When people feel a sense of ownership over their work and have skin in the game, outcomes improve. 

Meroka is here to empower doctors to practice independently for their entire career. We’ll help you build a practice, grow it, and, when the time is right, sell it — all on your own terms.