Reversing the Corporate Practice of Medicine

February 12, 2024

A Call To Action To Take The Profession Back from Corporate Interests
TAKE MEDICINE BACK
October 2023
By Mitchell Li, MD, Sailesh Konda, Robert McNamara

Conclusion:

The corporate practice of medicine doctrine was integral in providing an ethical basis for the practice of medicine. Today, the AMA explicitly tolerates the corporate practice of medicine, and state prohibitions on CPOM are broadly unenforced. The vast majority of physicians are now employees of increasingly consolidated corporations, while moral injury and burnout among physicians are at unsustainable levels. Rapid horizontal and vertical consolidation of non-physician healthcare corporations that employ physicians not only increases monopoly power over consumers, which in return increases costs, but also increases monopsony power over physician labor. This has resulted in anti-competitive labor practices that lead to intimidation of, and retaliation against physicians who advocate for patients. This places the public at risk through greater corporate influence over the practice of medicine. …

A new era of robust antitrust enforcement in healthcare is needed. Past FTC actions against the AMA restricting the ability to impose ethical restrictions on its members should be re-examined in the context of unintended consequences of enabling corporatization and consolidation. A national prohibition on the corporate practice of medicine is necessary to accompany the strengthening, and enforcement of existing state-based prohibitions. Physician organizations must collectively reject non-physician corporate ownership of medical practices. Reclaiming the profession from corporate interests will take time, and greater protections for employed physicians are needed now in order to protect patients. In the face of legislative inaction at the state and federal level, employed physicians should use the tools available to labor and organize through unionization.

[HJM bolding]

The Corporate Practice of Medicine By The Numbers 

74% – Physicians employed by corporate entities
34 – States prohibit the corporate practice of medicine to protect patients – and enforced in none of them.
87% – Of physicians say patients trust them less than they did a decade earlier
140 million – Americans facing financial hardship due to healthcare bills
$1 Trillion – Worth of private equity transactions in healthcare over the past decade.
63%  – Of physicians reporting burnout in 2020 – an all time high, and rising.
2.51 – Replacement ratio of physicians by non-physician practitioners in private-equity owned medical practices
1 in 4 – U.S. Medical Students are considering quitting their studies
58% – of U.S. Medical and Nursing students do not intend to treat patients
1 in 10 – physicians working under or for United Health

 

Comment by: Don McCanne & Jim Kahn

In 1980, NEJM editor Arnold Relman, MD issued the warning of the relatively unheralded rise of a huge new industry that supplies health-care services for profit which he labeled the “medical-industrial complex.” He concluded, “How best to ensure that the medical-industrial complex serves the interests of patients first and of its stockholders second will have to be the responsibility of the medical profession and an informed public.”

Apparently the medical profession and the public have largely failed in this responsibility – based on the statistics showing that private ownership and profits are shifting to private equity, yielding dissatisfaction of both health care professionals and, most importantly, patients.

Today’s HJM directs our attention to an organization that is sounding a call to action to “take the profession back from corporate interests.” The name of their organization is simply TAKE MEDICINE BACK. They have produced a very easy-to-read 63 page paper. Their recommendations are complementary to those of Physicians for a National Health Program and other organizations that support health care justice for all.

We should work together to take medicine back from private equity and the corporate world and use it to fulfill our dreams of realizing comprehensive, equitable, affordable, high quality care for absolutely everyone. Those of us who really care are now busy aligning ourselves in the direction that will get us there. Let’s go!