Hospital System Acquisition of Physician Practices.

Importance: More than 50% of physicians currently work for hospital systems compared with 20% in 2010, a shift driven in large part by hospital acquisitions of physician practices. These acquisitions have been linked to higher prices for physician and hospital services, and the evidence regarding their impact on quality of care has been mixed; however, there is little research regarding the perspectives of key stakeholders regarding such acquisitions. Objective: To provide systematic evidence on the motivation for and impact of physician practice acquisitions from hospital system leaders and physicians who are directly involved in these transactions. Design, Setting, and Participants: A qualitative research design was used for the study. Data collection occurred between December 2024 and April 2025. A purposive sample of 3 hospital systems that each had experience with physician practice acquisitions was included. Interviews were conducted with hospital system leaders and employed physicians who had been members of an acquired practice. Main Outcomes and Measures: Semistructured interview guides were used covering motivations for acquisitions, implications for patient care, and operational challenges. Coded data were analyzed to identify major themes. Results: A total of 37 interviews were conducted of 18 hospital system leaders and 19 employed physicians (26 male and 11 female). Both hospital leaders and physicians reported that practice acquisitions were most often initiated by physicians because of concerns about the financial viability of their practices. Hospital leaders and physicians also perceived that practice acquisitions improved care for patients, for example by uniting clinicians through a common electronic health record or colocating primary care and behavioral health services. Operationally, hospital leaders expressed frustration with employed physicians' productivity, whereas employed physicians complained of being sidelined in decisions about practice support and work schedules. Conclusions and Relevance: In this qualitative study of hospital acquisitions of physician practices, acquisitions were largely initiated by physicians seeking to leave independent practice. The acquisitions created opportunities to improve patient care, but efforts to integrate physicians after acquisition were impeded by ongoing tensions over physician productivity and autonomy. Physician practice acquisitions hold promise for improving patient care if various operational challenges on integrating acquired practices can be resolved.