From the desk of the EMD: I’m an Amazon allergist; you’re a Walmart allergist

June 4, 2018

Are you laughing at the title of this article? Are you confused by it? I think you are looking at the future of medicine in the U.S. – the “Amazoning” or “Walmarting” of medicine. How can I say this is the future? I am sure that “mom and pop” grocery stores, clothing stores and hardware stores never thought they would be out of business 15 years ago. I’m afraid the same thing will happen with the “mom and pop” allergist as we move into the realm of disruptive innovation in health care.

Why do I believe we are moving to “corporate” medicine? Let’s look at what is happening now in primary care and some specialties. In March 2018, The Physicians Advocacy Institute published their updated physician practice acquisition study. This research illustrated that, over the four-year period from July 2012-July 2016, there was a significant nationwide trend of physicians leaving private practice and entering into employment arrangements with hospitals and health systems. Nationally, over this period, the percentage of hospital-employed physicians increased by more than 63%, with rises in nearly every six-month period measured over these four years. As of July 2016, 155,000 physicians are employees. More than half of all physicians in the Midwest are employed by hospitals. Rates of employment are lowest in the South, where 37% of physicians are employed by hospitals, and in Alaska and Hawaii, where 33% are employed. As the Physician Advocacy institute points out, one of the main reasons we are seeing this trend is government and private payer payment policies. These increasingly favor integrated health care systems and make it more and more challenging for physician practices to remain independent.

I see nothing that is going to stop the movement of physicians employed in larger and larger medical groups being acquired by corporate America. The allergist must be vigilant to these changes and be flexible.

It is not just hospitals and health systems acquiring physicians. Giant retailers and health insurance companies are getting into the act in a big way. There was a fascinating article in the New York Times by Reed Abelson and Julie Creswell on April 7, 2018, called The Disappearing Doctor: How Mega-Mergers are Changing the Business of Medical Care. They discuss the possible mergers of CVS Health with Aetna and Walmart with Humana as we move to giant one-stop shops in health care. By forming more vertical integration of physicians, hospitals, pharmacy, pharmacy benefit managers and health insurance companies, one company can offer all health services and possibly control costs. They mention how these mergers are leading to the replacement of typical primary care office visits by urgent care retail clinics in our need for convenient, anytime health care. The authors state, “On top of these corporate partnerships, Amazon, JP Morgan and Berkshire Hathaway decided to join forces to develop some sort of health care strategy for their employees, expressing frustration with the current state of medical care. Their announcement, and Amazon’s recent forays into these fields, are rattling everyone from major hospital networks to pharmacists.”

In other words, we may be moving to a few vertically-integrated mammoth retail health care/insurance systems where you would get all your care. Perhaps you would choose to enroll in the Amazon system. You would get an Amazon primary care doctor who may care for you at your neighborhood Whole Foods Market and refer you to an Amazon allergist. Your prescriptions come in the mail from Amazon Prime. If you need hospitalization, the Amazon Hospital System will take care of you.

Is this the future of health care? I see nothing that is going to stop the movement of physicians employed in larger and larger medical groups being acquired by corporate America. The allergist must be vigilant to these changes and be flexible. Is this doom and gloom for the allergist? Absolutely not! We are a valued scarce commodity – as the number of allergists is not growing. I believe we will continue to do well in the changing practice of medicine. The College stands with the community allergist and will work hard to support the specialty in whatever changes occur in the health care arena.

Michael Blaiss, MD, FACAAI, Executive Medical Director