An OB-GYN explains why she closed her practice after 27 years | Viewpoint

Like most doctors, I always felt a calling to care for people. Quitting early wasn’t my plan, but our broken health system left no other option. December 2024 marked the close of my 27-year, solo, OB-GYN practice, leaving 2,500 Ohio women looking for a new doctor. My only available choice was to retire.

While most workers reach peak earning years in their late 40s and 50s, for me, the highest salary I ever earned was the $150,000 I took home in 1997, the year I took over a private practice. By the time I closed my office, I had so little money coming in that I had stopped taking a salary. Instead, I was using my own savings just to keep the practice afloat.

Over the years, I tried everything to reduce costs. I relocated my office to save on rent, eliminated staff positions, and cut my salary so I could keep paying my remaining employees. It only delayed the inevitable.

You don’t have to be a physician to know Band-Aids won’t save a critically ill patient. The combination of Covid-19 slowdowns, inflation, and a steady, two-decade decrease in pay from both Medicare and private payers made my small practice unsustainable. And I’m not alone.

As the speaker of the American Medical Association House of Delegates, I preside over the policymaking body of the AMA in which physicians tackle the biggest issues in health care. At our November meeting, I guided delegate discussions about our broken Medicare payment system, out-of-control prior authorization demands, and insurance industry consolidation — the very challenges to which I was succumbing.

Independent doctors like me are becoming an endangered species.

The AMA believes physicians should practice in whatever environment works best for them, including private practice. But increasingly, because of the way Medicare pays physician practices, that option is disappearing. Between 2012 and 2022, the share of physicians working in private practice fell by 13 percentage points, from 60.1% to 46.7%. Sadly, I doubt this trend will ever reverse, and private practice as we know it will never come back. And when those practices disappear, patients lose a critical touch point — local, small-town doctors like me — in an increasingly complex and impersonal health system.

Here’s why: When adjusted for inflation in practice costs, Medicare payment to physician practices has dropped 33% since 2001. According to an AMA analysis of data from the Medicare Trustees Report and the Federal Register, Medicare physician payments increased only by 7% between 2001 and 2025, or just 0.3% per year. Meanwhile, the cost of running a medical practice — which includes everything from office rent and staff salaries to electronic medical records and liability insurance premiums — rose 59%.

OB-GYNs see relatively few Medicare patients, but this problem still affects us. Private insurance companies see the dizzying downward spiral of reimbursement rates for our practices, and most of their clients aren’t aware their contracts are based on those Medicare rates. So, when it’s time to renew contracts, private payers’ proposals mirror the decreases in what Medicare pays. In a time of rampant market consolidation, there’s no room for negotiation, especially for small practices like mine with no bargaining power. Take it or leave it; accept the untenable payment rate or take your practice out of network, making it inaccessible and unaffordable for patients.

There are ways we can stem this tide. Earlier this year, the Medicare Payment Advisory Commission (MedPAC) recommended linking next year’s physician payment update to the growth in the cost of providing care. The AMA strongly supports tying Medicare updates to the full Medicare Economic Index, which calculates practice cost inflation.

When Congress receives MedPAC’s report in March, the AMA hopes lawmakers recognize a dire situation. In 2024, Congress allowed a fifth consecutive year of Medicare cuts — this time by 2.8% — despite practice costs rising by 3.5%. It is imperative that Congress not only reverse those cuts but find a sustainable way forward to link Medicare payment to inflation.

Running my own practice was my dream since I decided to pursue a career in medicine, and it meant forging relationships with generations of patients. I had a picture on my wall of the three cousins I delivered within weeks of one another to two sisters and their sister-in-law. Every teacher at a local grade school came to me based on word-of-mouth recommendations from colleagues. Babies I delivered early in my career came back to my office as young adults brought by their mothers and even grandmothers. As word of my closure spread, I received heartbreaking letters from patients thanking me for all I’ve done for them and asking me to reconsider. I have an entire drawer full of these notes, but the wounds are too fresh to read all of them now.

For my practice and my patients, solutions are coming too late. I want to keep working. My patients want a doctor who knows them. Congress can fix this problem. But will it?

Lisa Bohman Egbert, MD, is an OB-GYN in Dayton, Ohio, and speaker of the AMA House of Delegates. This op-ed was originally published by STAT.