Doctors cite downsides in hospital, health system mergers

More hospitals and health systems are consolidating across the country, and many organizations tout the potential of mergers to expand care options for patients.

Gary Price, MD, president of The Physicians Foundation, says doctors are seeing more burnout and less job satisfaction after health system mergers.

But some doctors are seeing serious drawbacks in the wake of health system mergers. In fact, doctors say healthcare mergers are adding to their feelings of burnout and reducing their job satisfaction, according to a new report from the Physicians Foundation.

Gary Price, MD, president of The Physicians Foundation, tells Chief Healthcare Executive® that mergers are falling short of their promises for doctors and patients.

“The bottom line is that consolidation is here,” he says. “We can no longer talk about how rapidly it's occurring. It has occurred, and it's dramatically shifted the way physicians practice medicine, and they're perceiving all sorts of negative effects on their patients and the system itself.” (See part of our conversation with Dr. Price. The story continues below.)

Roughly seven in 10 physicians (68%) say that healthcare consolidation is hurting patient access to top-notch, affordable care, according to the foundation’s survey. About six in ten residents (61%) and 70% of medical students expressed similar sentiments.

“Interestingly, access to care was one of the things that was supposed to improve dramatically with consolidation, as was the cost of care, as was the efficiency of care,” Price says. “The financial stability of the institutions that were consolidated was listed as a benefit of consolidation. And not only has the promise of that not come to fruition, but we're seeing this is tied in heavily to the phenomenon of physician burnout.”

Half of the doctors surveyed (50%) said they had less satisfaction in their jobs after a healthcare merger. The foundation surveyed more than 1,700 participants, including more than 1,000 physicians, along with a mix of residents and medical students.

After a slowdown of hospital mergers during the worst of the COVID-19 pandemic, more hospital deals have taken place over the last couple of years. Analysts expect to see more hospital deals in the coming months, especially as some struggling organizations look to find partners to stay alive.

Physicians say part of their frustration is the realization that the promised advantages of a health system merger - for caregivers and patients - aren’t coming to pass.

“The typical story we hear from a physician whose practice has been acquired and merged into one of these big systems is at least a brief honeymoon,” Price says. “But then requests for the physician to see more and more patients in less and less time.”

“They become very frustrated with the fact that they're repeatedly being asked to deliver care that they don't think is up to the standards their patients deserve, and this creates a tremendous sense of frustration and loss of control. And if you look at any profession or occupation, that's a key element in the development of burnout,” he says.

About a third (30%) of doctors say healthcare mergers are leading to higher costs for patients, the survey found.

“That was one of the top negative impacts that the physicians we surveyed noted,” Price says. “A large percentage of physicians felt that it was actually increasing the cost of care and decreasing the efficiency with which it was delivered.”

While a strong majority of physicians said they felt healthcare mergers were reducing access to patients, a smaller number of doctors said that consolidation was contributing to a drop in the quality of care. A little more than a third of the physicians surveyed (36%) said they saw a reduction in the quality of patient care after a merger.

Price sees that finding from the survey as disturbing, and says that’s a significant number of doctors complaining of a reduction in the quality of care.

“That struck me as extremely concerning, that three out of 10 physicians feel like the care their patients are getting isn't as good as it was a year ago, basically,” Price says. “So I think that is concerning. And I think it actually underestimates a number of physicians who would admit to that if there were a group of them talking together about how they feel our healthcare system has changed.”

Physicians also say they are getting pressure to see more patients after a merger or acquisition, meaning less time with individual appointments, Price says. And that’s a sore point for doctors.

“The number one source of satisfaction for physicians in their jobs is the time they're able to spend with their patients,” he says.

The Physicians Foundation surveys doctors about their job satisfaction and feelings of burnout each year. Doctors routinely cite administrative burdens as a leading cause of burnout, with doctors losing time on coding, dealing with electronic health records, or hassles in getting approval from insurers for treatment plans.

Some doctors see persistent administrative hassles after mergers, despite hopes that larger organizations would offer more resources and physicians would spend less time dealing with bureaucratic burdens.

“These systems were supposed to make them more efficient and give them more time, but much like the promise of consolidation itself, the effect has actually been quite the opposite,” Price says. “A lot of work to be done there.”

Doctors cherish a sense of autonomy, and the idea that they can work with patients to make the best choices for their care.

Too many physicians say they are losing that sense of autonomy after a merger, Price says.

“They no longer really are deciding on the care that their patients get,” Price says. “They have lost control of that, and it's been yielded to insurance companies, to care pathways that don't necessarily fit the needs of individual patients, financial concerns of the healthcare system itself, a myriad of things.”

“So all these things have conspired to take that time away,” he adds. “And yet at the same time, what they hear from their administrators is that they need to see more patients in 15 minutes, not spend more time with each patient. So you have the cycle of frustration, which is coming down on the one person in the whole system who is ultimately held accountable for what happens to the patient, but feels that they no longer control it.”

Coming tomorrow: Doctors continue to experience high levels of burnout, and health systems need to do more to help.