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Physician Experiences in Health System-Owned Practices and Independent Practices: Insights From Interviews With
Sara G McCleskey1, Maria DeYoreo1, Shiyuan Zhang2
1RAND, Santa Monica, California.
Purpose:
Health system ownership of physician practices has grown rapidly, yet little is known about how health system structures and processes affect primary care physicians' day-to-day experiences while delivering care. We aimed to examine how practice ownership influences physician experiences with autonomy, care coordination, infrastructure, and patient relationships in health system-owned versus independent primary care practices.
Methods:
Qualitative study using semistructured interviews were conducted from March through May 2024 with 30 primary care physicians: 15 employed by health systems and 15 practicing independently. Using qualitative content analysis, we compared perspectives on practice infrastructure and operations across settings.
Results:
We identified 5 major themes: (1) health system physicians reported less autonomy in scheduling and operations, but greater financial and legal protections; (2) health systems offered embedded clinical support teams and easier access to specialists, while independent physicians managed needs with limited staff; (3) shared electronic health records and integrated networks in health systems facilitated care coordination and specialty care access while independent physicians relied on manual outreach and professional relationships; (4) health system physicians worked within cultures emphasizing productivity and performance metrics, whereas independent physicians prioritized time and continuity with patients; (5) centralized communication structures hindered patient access in health systems, while independent physicians valued responsiveness.
Conclusions:
Primary care physicians in each model face distinct trade-offs influencing care delivery and satisfaction. Health systems provided resources that support integrated care but often constrained physician autonomy and patient accessibility. Independent practices fostered operational flexibility and stronger relationships yet lacked multidisciplinary support.
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