The solo physician practice has gone the way of the house call. But are patients better off?

If there’s any trend that’s reshaping medical practice, it’s the end of the solo practitioner. Like physicians making house calls, gone are the days of one or two doctors going into business on their own.

In every region of the country, an increasing number of doctors are making the move from private practice to a hospital or a larger medical group with dozens of other physicians. There are a multitude of reasons for the shift, from lifestyle factors to changes around how doctors are paid to the significant investment in technology that’s now required. For patients, it can be mean more around-the-clock coverage but also a higher likelihood that their care will be managed by a team, for better or worse.

Hospitals employed 38% of the nation’s doctors in 2015, up from 26% in 2012, according to a September study from Avalere Health. In raw numbers, that’s 46,000 physicians who shifted from private practice to hospital employment.

And the trend is accelerating: as many as 20,000 doctors made the jump between 2014 and 2015 alone.

For hospitals, the move to employ their own physicians has been rationalized as a way to improve quality by allowing them to have population-level data on a wider number of patients. The more data they have, the argument goes, the more hospitals can begin to understand how to keep people healthy and intervene before they get sick. Hospitals can also standardize care to make sure that doctors across the institution are incorporating the most up-to-date guidelines and protocols.

There’s a strong business case for hospitals as well. Employing more physicians in a geographic area is a competitive strategy to control more patient volume and gain more leverage when negotiating with insurance companies. (The Federal Trade Commission has been closely watching this space and has shown a willingness to go after physician deals it deems anticompetitive. The regulatory agency, for instance, successfully blocked St. Luke’s Health System, a Boise, Idaho-based hospital network, from acquiring Saltzer Medical Group.)

Yet there are already signs that the strategy hasn’t been paying off. Hospitals are incurring big costs in taking on doctors’ salaries and benefits—not to mention office space and support staff—which are straining their balance sheets.

And now a study last month in the Annals of Internal Medicine is poking holes in the quality side of the argument. Hospitals that switched to an employment model, the authors found, failed to show any improvement on four quality metrics even up to two years later.

LinkedIn asked doctors and hospital administrators to weigh in. In a series of posts on LinkedIn, some healthcare professionals pointed to flaws in the study design, while others questioned whether hospitals are really committed to improving quality, arguing that a hospital’s true objective is economic.

The Fear of Being Left Behind

“I think most of the move toward direct employment has been a defensive reaction by both physicians and hospitals in response to adverse long-term financial trends, not a desire to change the way care is delivered,” wrote Dr. Lucius Wright, who practices at the Jackson (Tenn.) Clinic, in a post on LinkedIn. “Presently, most people are changing only to avoid the fate of [being] the last duckling to get back on the ship.”

The study did have a number of limitations, including the fact that only Medicare patients were included in the analysis, noted Dr. Samer Narouze, a headache and pain specialist at Ohio State University. Moreover, most of the hospitals that switched to an employment model were large academic institutions, likely weighed down with legacy processes and bureaucratic red tape.

“Large institutions, although [they] may have more advanced technology, usually deprive their employees from the desire to innovate,” Narouze wrote in a post on LinkedIn.

But the study also suggests that numbers alone don’t increase quality, and that hospitals may need to be more proactive in order to achieve their aims.

“The results are not unexpected,” wrote Dr. Steven LaRosa, an infectious disease specialist at Beverly (Mass.) Hospital, in a LinkedIn comment. “It does not matter if the physician is employed or not but what their skill level is and motivation.”

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