AEI Fellow: Small Doctors’ Practices Will Be Killed Off by Obamacare

The Affordable Care Act, in its doomed effort to control costs, will push independent doctors to hospital chains, says Scott Gottlieb, a resident fellow at the American Enterprise Institute and a physician himself.

“Big government likes big providers,” he writes in The Wall Street Journal. “That's why Obamacare is gradually making the local doctor-owned medical practice a relic. In the not too distant future, most physicians will be hourly wage earners, likely employed by a hospital chain.”

Washington can’t assert its control over independent physicians when they’re spread out widely, Gottlieb says. “When doctors practice in small offices, it is hard for Washington to regulate what they do.

“There are too many of them, and the government is too remote. It is far easier for federal agencies to regulate physicians if they work for big hospitals. So Obamacare shifts money to favor the delivery of outpatient care through hospital-owned networks.”

But the attempt to cut costs will likely result in just the opposite, Gottlieb says. “Obamacare will almost certainly make the practice of medicine more expensive. It turns out that when doctors become salaried hospital employees, their overall productivity falls.”

That lost productivity doesn’t stem from fewer procedures being performed, the aim of Obamacare, Gottlieb writes. “Rather, the lost productivity is a consequence of the more fragmented, less accountable care that results from these schemes.”