Just a few decades ago the physician was an independent small business man. When completing his or her training, he or she was able to open an office. Those days are pf the past for most physicians starting out. Encumbered with debt from prolonged schooling and training the cost of starting an independent practice becomes prohibitive. In a few instances, if the physician is willing to go to a rural area, it may still be possible to be independent, but for most, this is not easily possible. The independent physician does not have a patient base and it may not be easy to contract with health insurance companies.
The result of all this is simple. The physician starting out has to assume a job with a company. The result is that the majority of physicians have become employees. The ethical new physician guided by AMA ethics was supposed to place an ad no larger than a business card in the newspaper. Today the businesses which employ physicians take out full page ads, while most independent physicians could afford to treat the needy patient for nothing or whatever they were able to pay, this is no longer possible. The businesses that employ physicians have no pity and do not feel obligated to provide services for nothing. The physician once upon a time had the luxury of being able to refer patients to the specialist of his choice. This is no longer possible and referrals are determined by the parent organization.
Hospitals that can afford hospitalists are not anxious to see outside physicians come in. They also like to run hospitals without input from physicians. The companies that employ physicians also like to see them stay at their desks and see patients, rather than running off to the hospital, a not so profitable diversion in most instances.
There are of course some advantages for the physician, no night call, regular paycheck, and regular hours.
The question now arises, as employees, doctors have little bargaining power and protection from the Medical Associations is rather skimpy at best. It may well be that organizations that will protect our interests may become necessary.
The physician as a small independent businessman has passed along with the dinosaur.