‘I don’t want to give up.’ As hospitals get bigger, an independent doctor feels the pinch

Before the coronavirus pandemic, Dr. Andrew Bush treated as many as 1,000 patients every month in his orthopedics practice. Now he worries about going bankrupt.

The surgeon is among a dwindling number of independent physicians in the United States, where doctors are selling their practices to behemoth hospital systems or leaving the profession altogether.

“I don’t want to give up, because I’m a fighter,” said Bush, whose practice, Central Carolina Orthopaedic Associates, serves a blue-collar town of about 30,000 people. “But our summer numbers were so bad. I don’t know what’s going to happen.”

Personal safety risks and fatigue caused by the pandemic have played a role in some doctors’ decisions to retire or sell their offices to giant hospital systems, an outcome Bush is trying to stave off.

But some physicians and experts say the trend also underlines how billions of dollars in federal aid at the beginning of the crisis favored large hospital systems, even as lawmakers vowed to fight consolidation.

“The rich got richer, and the poor got poorer,” said Ge Bai, a professor of accounting and health and policy management at Johns Hopkins University, who reviewed how much relief money went to large hospital systems in North Carolina.

The infusion of public money allowed big chains such as Atrium Health, a regional system headquartered in Charlotte, and Duke Health, based in Durham, to post bigger profits or continue to pursue mergers.

“If you have the strength and courage to hold on as an independent physician, your life is going to be hard,” Bai said.

Bush’s practice has financial problems even though he received $300,000 in federal COVID relief aid meant to help both hospitals and small operators stay afloat. He halted most in-person visits and canceled surgeries at the start of the pandemic, concerned that patients could catch the virus.

As an independent physician in a town where the poverty rate is nearly double the national average, Bush said his prospects remain grim even as society returns to normal. About 15% of Sanford residents younger than 65 lack health insurance, according to the U.S. Census Bureau.

Patient visits drop since the pandemic

Bush said patient visits have recovered only to half of the pre-pandemic levels because residents are grappling with high inflation and can’t afford to go to the doctor.

According to a nationwide survey conducted by the Physicians Foundation in 2020, an estimated 8% of physicians closed their practices in the early months of the pandemic, and an additional 4% planned to do so.

Grants, loans, and other assistance intended to help hospitals and doctors remain solvent went disproportionately to wealthy hospitals that did not need the money as urgently as independent practices and struggling rural hospitals did, according to research reports from two states and interviews with academics and doctors.

The U.S. Department of Health and Human Services, after multiple requests, did not make any officials available for an interview to discuss how COVID funds were disbursed.

Despite the federal government’s reluctance to answer questions about the economic impacts of COVID relief distribution, some analysts said the results are visible on the ground in places like North Carolina.

A state treasurer’s report found that seven large hospital systems in North Carolina received $1.5 billion in COVID relief money while collectively seeing their cash and investments grow by $7.1 billion from 2019 to 2021.

Atrium Health, for example, received the most money in the state, with $589 million in COVID relief aid and $438 million in a type of emergency Medicare payment that boosts hospitals’ cash flow by providing money upfront for future services. The report found Atrium posted $1.7 billion in net profit in 2021 after a merger with another hospital system.

Atrium did not respond to multiple emails requesting comment.

Bush said COVID relief aid helped him meet payroll for his 13 employees. He said the aid did not cover losses from canceled surgeries and office visits.

Bush would not provide numbers but said his practice has not been profitable since at least 2018.