Daniel Choi, MD, was a medical student when the Affordable Care Act was implemented, and 15 years later he said its long-term outcomes emphasize the importance of private practice.
Dr. Choi, a private spine surgeon at Spine Medicine and Surgery of Long Island in Ronkonkoma, N.Y., said he felt the intent of the ACA was good, but after 15 years he’s worried about the subsequent mass consolidation across the U.S. healthcare system.
“You have these big, gigantic health systems [consolidating] and United Healthcare being the biggest employer of physicians,” Dr. Choi told Becker’s. “What has actually happened now is that private practice has pretty much died out, and more than 70% of physicians are now employed. Even though it was entitled ‘The Affordable Care Act’ and it was meant to give coverage to more patients, which it did, there’s been a bunch of unintended consequences.”
Dr. Choi said he felt that increased consolidation has reduced competition and lessened efficiency in the healthcare system.
“Then prices go up because there’s not enough people competing for not enough entities competing to deliver healthcare,” he said. “And we used to have private practice as a very robust part of the healthcare delivery system and it’s not a part of the ecosystem anymore. Private practice is really dying out. Hospital systems and private equity as well as Optum, have just come up there and snapped up private practices and brought them into their systems, and that’s really just made care more expensive and less accessible.”
Other downstream effects that Dr. Choi said he was concerned about include the physician shortage, loss of autonomy and barriers to patient access. All these factors have led some physicians to burn out and in some cases retire earlier.
Dr. Choi’s concerns became part of a wider conversation among physicians and consumers after Elon Musk reshared his post reflecting on the ACA and his experiences on X, formerly known as Twitter. Dr. Choi said his tweet got more than 48 million views and more than 3,000 replies.
“The general gist I was getting was that there are very angry Americans who have been hurt and burdened by the system in the last 10 years,” Dr. Choi said.
Working in private practice Dr. Choi said that he’s able to have more flexibility when it comes to business operations.
“We have the flexibility as an independent practice, and we really want to put our patients first and serve the community,” he said. “Our practice does not take patients to collections. We try to collect on our bills, but we don’t try to financially hurt our patients. It’s tied to our ethics, and we don’t want to have patients be scared of losing their house or their car, so we don’t go down that road. That’s also something that private practice could be flexible with compared to corporate medicine.”
The changes Dr. Choi said he wants to see in healthcare boils down to one thing: restoration of the viability of private practice.
“When it comes down to it, I think that unlocks the key to so many things that are badly needed in our healthcare system and especially for the physicians,” he said. “The viability of private practice is tied to so many different things that we need to happen from a regulatory and legislative standpoint.”
He also said it’s imperative for legislators to listen to practicing physicians’ considerations.
“If you don’t take that into consideration, you’re just going to keep forcing the problems that are driving burnout and decreasing the supply of physicians … There’s a lot of regulatory and legislative issues that can be fixed to help make the healthcare environment more competitive, encourage more competition and encourage more innovation, and that will be beneficial to all.”