The changing health care landscape

Market forces and the Affordable Care Act are together reshaping how health care is organized in Atlanta and across the nation. Doctors are less likely than ever to operate independent solo practices or small groups of specialists.

Instead, doctors and hospitals are coming together to form health care systems that can care for a patient’s every need in multiple hospitals and outpatient facilities. This ongoing consolidation and integration of the health care system is taking place as doctors and hospitals prepare to be paid in a different way.

In the future, health systems do not expect to be paid separately for every surgery, ER visit and annual physical, as is the case in today’s fee-for-service approach. Instead, insurers and government payers are likely to pay the health systems a set fee for handling whatever a patient needs. Other models call for the systems to win financial rewards for efficiency and quality instead of simply being paid more to perform more services.

Many doctors fear that if they do not hitch their practices to a health system soon, they may find it difficult to elbow their way into a system that is winning contracts to provide care. While some doctors are becoming employees of health systems, others are signing professional services contracts that allow them to maintain some of the independence that many physicians value.

Where doctors are working

More and more physicians are selling their ownership interest in their practices (or never assuming such an interest in the first place) and becoming employees of health care systems. Here are nationwide results from the Physicians Foundation's Biennial Survey taken in 2012. The Medical Association of Georgia says that about 40 percent of its members now work for someone else.

Employed by hospital or group: 43.7%

Practice owner/partner/associate: 48.5%

Other: 7.8%

Pessimistic about medicine

The Physicians Foundation’s Biennial Survey polled physicians about their attitudes toward their profession. They are decidedly pessimistic now and even moreso about the future.