By Marco Fernandez, M.D. 

Independent physicians rarely end up in the same room. We practice in different specialties and different states, and we are usually fighting different fights, alone, between cases. This month in Chicago, the Association for Independent Medicine convened our first Independent Physician Summit, and the message I wanted every person there to carry home was simple: We are not done yet. 

To see why, you have to understand what is being done to us. The first step is to name it. 

The forces reshaping medicine are not random. They flow from an idea: that healthcare is a commodity, that consolidation equals efficiency, and that a spreadsheet in a private equity office two states away can make better decisions about a patient than the physician at the bedside. 

That idea has a name: neoliberalism, applied to medicine. It has succeeded not because it is true, but because almost no one says its name out loud in a room full of doctors. 

Once you name the idea, the machinery comes into view. Management services organization structures are built to route around laws that regulate the corporate practice of medicine. Staffing companies win hospital contracts by being bigger, not better. Hart-Scott-Rodino reporting thresholds let hundreds of small acquisitions pass without a regulator asking a single question. Roll-up follows roll-up, in gastroenterology, dermatology, anesthesia, radiology and emergency medicine, until a specialty wakes up and finds that a few companies own most of it. 

This is not a conspiracy. It is arithmetic, running unchecked for a very long time. 

For years, I thought this was somebody else’s problem: a hospital problem, a policy problem, something happening near medicine rather than to it. I am a board-certified cardiac anesthesiologist. I led Midwest Anesthesia Partners, LLC, as both a practicing clinician and its president. For 30 years, our group had kept patients safe in the operating rooms of the hospital that would terminate us. 

In August 2021, we were blindsided twice in two weeks. One of the takeovers was led by a board member of my own national society, who also served as national medical director of a private equity-backed staffing company. Consider what that means. Someone in the leadership of the society that exists to represent us was sitting on the other side of the table. Twenty of our members stood in solidarity and walked out. Thirty years of loyalty did not matter. Quality of care did not matter. The hospital had been granting us monthly contract extensions, stalling negotiations until it decided to terminate us. 

I remember reading the notice and thinking that I had trained for a decade to care for patients, and none of it mattered. 

Then the hospital made a critical error. The new entity was not contracted to begin until October, which left September with no coverage at all. Surgeries were transferred to surrounding hospitals. The hospital temporarily lost its trauma designation. The community was in an uproar. Many of our members stayed with our organization at other sites, and some left for jobs closer to home. The surgical program was disrupted for years. 

That is what makes this form of consolidation so hard to see from Washington. Nothing was merged. No filing was required. A competitor was displaced through a procurement process, and the terms of the winning bid were never shown to the clinicians who lost. 

In January 2022, I spoke up at a town hall meeting at that same national society’s conference. The society chose to remain agnostic. That November, we launched AIM to support, educate and advocate for independent physicians. Those two weeks are the reason it exists. I suspect nearly every independent physician has a version of a time when the abstraction became a real letter with their name on it. 

So what do we do with that moment? We move, and we move together, because the only thing that has ever counterbalanced consolidated capital is consolidated conviction. 

Physicians are well positioned to lead this movement. In a midterm year, few messengers are trusted more than a doctor. When we tell a patient, a neighbor or a state legislator what consolidation has done to care, the waits, the churn and the decisions made by people who have never met the patient, it lands because it is true and because we have nothing to sell. The corporate practice of medicine doctrine will be strengthened or hollowed out in statehouses, and bills like Illinois HB 5000 and Oregon SB 951 – both which have passed and strengthen oversight of healthcare consolidation and private equity acquisitions and protect physicians’ clinical independence by ensuring medical decisions remain in the hands of licensed physicians – are where that contest is playing out. At AIM, we have taken that case to Capitol Hill and the National Press Club, and we are building coalitions with anti-monopoly and consumer protection groups. Advocacy is no longer something we do in addition to practicing medicine; these efforts must exist in lock-step. 

My confidence comes partly from an unlikely source: a health policy scholar. Dr. John McDonough, a professor at the Harvard T.H. Chan School of Public Health, served in the Massachusetts legislature and worked on the Affordable Care Act. His new book, America’s Wrong Turn: US Health Care in the Neoliberal Era, dates the break to 1980, when American health care stopped resembling that of its peers and became a category of its own. He documents how concentrated our markets have become, in hospitals, physician specialties and insurance, and what that concentration has cost patients. 

What I take from his work is not despair. It is the opposite. If the system we live in is the product of choices made in a particular era by particular people, then it can be chosen differently. McDonough does not stop at diagnosis. He calls for radical action: stronger antitrust enforcement, tougher regulation of drug pricing and a health system reoriented around patient care, equity and affordability. He writes as someone who has worked inside the legislative machinery, and he knows how it moves. 

We have the credibility and, increasingly, the coalition to make the radical changes needed. These fights are winnable. Let’s go win them. 

Dr. Marco Fernandez is a physician and co-founder of the Association for Independent Medicine (AIM), a national organization advocating for physician autonomy, patient-centered care, and policies that protect independent medical practices from corporate consolidation.