The cycle of hospitals acquiring physician practices is one with which we are all familiar. Hospitals purchased more than 8,000 physician practices from July 2016 to January 2018, and an estimated 14,000 physicians left private practice to pursue employment arrangements with hospitals. With the purchase of these practices, hospitals have taken over the financial administration of physician practices—in a sense. Many hospitals allow acquired practices to continue operations much as in the past, but have overlaid administrative overhead and put administrators in charge, removing physicians from active engagement around the “business” side of physician practices. Some physicians prefer this model, as the move from ownership to employment is partially prompted by the desire to focus solely on providing care. Further, more physicians are entering employment immediately after medical school; as of 2016, 85% of specialists and 88% of primary care physicians under 40 are employed. These physicians have little to no training on the business of healthcare. In a survey of 1,400 physicians, some claimed they “had not been trained to understand the financial consequences of their decisions for the patient or the health system overall.”
