The old style independent doctor has continued to disappear. Practicing in a hospital has become a better financial deal, as the costs of insurance rise, and the income from visits, and procedures falls.

According to consulting firm Accenture:

A growing number of U.S. doctors are leaving private practice for hospital employment and only one-in-three will remain independent by the end of 2016

The trend is by no means new:

The number of independent physicians has declined over the last several years, from 57 percent in 2000 to 49 percent in 2005.

And, there are only a few reasons

The two factors that physicians cited most often as their biggest concern with remaining independent were reimbursement pressures and overhead cost, cited by 36 percent and 23 percent of respondents, respectively. With that, some independent doctors are choosing to opt-out of public programs, such as Medicaid (cited by 26 percent of respondents), health exchange plans (15 percent) and Medicare (3 percent).

The trend raises a “quality of care” flag, particularly for people who are part of government programs which reimburse expenses. This presumes that, in some cases, independent doctors provide a better level of care than hospital based physicians. And, if so, that level of car model is disappearing

One the other hand, the level of care independent doctors can give faces potential erosion

Meanwhile, in response to revenue and cost pressures, other independent physicians are experimenting with low-staffing models, such as reducing support personnel (22 percent) or extending office hours (21 percent).

If office staff quality is an important part of overall medical treatment, then the staffing trend is a blow to the care of people who opt to stay with independent doctors receive.

The changes add up to one thing for certain. The choices people have in picking physicians are well along the way to fewer options. And, if competition is a means to offer excellent care, the patient population faces trouble.

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