Facing declining revenue prospects, physicians are shuttering their private, independent practices to join up with larger hospitals that have near-monopolies on care in the regions they serve. 

This trend is depressing news for Americans. Further concentration of market power in these health systems ultimately results in less personalized care for patients—and higher overall costs. 

Over the past 20 years, Medicare physician pay has increased 11 percent. The overhead costs of operating an independent medical practice, on the other hand, has jumped nearly 40 percent. Factoring in inflation, Medicare physician pay has dropped roughly 20 percent in the past two decades. Clearly, those who remain in the sector aren’t in it for the money. 

For many independent physicians, not even a miracle could make this business model sustainable. Perhaps that’s why 2020 marked the first year independent physicians accounted for fewer than half of all practicing doctors in the U.S., according to a survey from the American Medical Association (AMA). 

Physicians closing up shop short of retirement typically go to work at larger hospital systems, many of which enjoy a monopoly on health care services in their catchment area. According to the AMA report, the number of physicians employed at hospitals increased roughly 50 percent between 2012 and 2020. 

In addition to poaching physicians, hospital systems are acquiring private practices outright. AMA data show that between 2012 and 2020, the share of doctors working at a private practice that was at least partially owned by a larger hospital system grew nearly 40 percent. 

And as the AMA survey notes, the majority of doctors employed by hospitals are under the age of 40. That suggests this trend will continue over the long term.

Many younger doctors prefer the more regular hours that hospitals offer, as well as a fixed salary. 

Nevertheless, the shift away from private, independent care towards corporate mega-providers should alarm patients and policymakers. 

For starters, care will become more expensive as hospitals expand their regional monopolies. As health systems grow, they gain undue leverage with insurance providers to propose service-price hikes. One study in the Journal of Health Economics found that prices for physician services rose nearly 15 percent at practices acquired by hospitals between 2007 and 2013.

Without competition from independent practices, hospitals have little need to keep a lid on prices. They can effectively charge patients and their insurers whatever they want to.

Diminishing quality of care is another concern. Physician pay within a hospital system is determined in part by how many patients each doctor can treat, assembly-line style. So much for patient-centered care. 

We’re witnessing a historic shift in the practice of medicine in the U.S. And it isn’t an edifying spectacle, especially if you’re a patient in need of medical care that is humane, attentive, and not delivered on a conveyor belt.