The future of private practice for physicians does not look bright. A recent Physicians Foundation survey of 20,000 U.S. doctors found that about a third (35%) described themselves as independent. That is down from two-thirds (62%) in 2008. In less than a decade independent doctors have gone from being the rule to the exception. Scott Gottlieb of the American Enterprise Institute predicts that this trend will continue unless there is quick reform of our health care system. The Medicare payment system is forcing doctors to sell out to hospitals. There will be a continued “consolidation of previously independent doctors into salaried roles inside larger institutions” (usually a central hospital). He argues that members of Congress need to pursue a different course. If not, local competition between medical providers will diminish. That will make it harder to implement market-based alternatives to Obamacare. He proposes legislative remedies that the next Congress should pass. Congress should remove the bias in Obamacare that favors hospital ownership of medical practices. Many of the current payment policies “are tilted far in favor of having hospitals pool their risk, and not looser networks of doctors.” Real reform will come when Congress gives independent, private-practice doctors an equal footing. They should be allowed to band together and bid against hospitals for a pool of patients. They also deserve an equal footing when it comes to reimbursement. Medicare currently pays much more for a procedure performed in a hospital than in a doctor’s office. This is true of everything from a colonoscopy to even a 15-minute doctor visit. This is another reason why hospitals are buying doctor practices. We should be concerned about government policies that are forcing doctors out of private practice. And reformers need to do a better job of explaining how market-based alternatives to Obamacare will be better for doctors, patients, and the American taxpayer. http://ncfr.net/ncfr.net/subdomains/commentary/Downloads/Kerby_Anderson/12-16-2014.mp3