To that point, locally here, most of the medical facilities are owned by the hospital - To include the private medical offices - More than less, the doctors ALL work for the hospital. There's but a handful of private practitioners that have privileges but remain autonomous. And I mean a handful. Five, maybe. All the rest have sold out to the medical borg.
So what hospital corp admin says, pretty much goes, or any who have capitulated that try to rise up will lose everything. Not just privileges, but office space, administrative employees, their entire infrastructure.
@roamer_1 Back 30 years ago,when this area had maybe 1/3 of the population it has today,there were 3 private medical practices in this county.
Today there are none. There were two as recently as a year ago. One was owned and operated by the son of a farm family with money,and the other was operated by the daughter of a family I know very well.
In the first case,the farm boy with money came down with cancer and had to close his clinic,and in the second case the female doctor had to go work in a hospital over 1,000 miles away at first,but is now working at a hospital only 60 miles or so away. She had to close her doors due to two situations beyond her control. The first was after putting thousands of dollars and who knows how many hours into refurbushing an old farmhouse and turning it into
a medical clinic,the owners decided to sell it and gave her 30 days to come up with the money to buy it.
Unfortunately,she had a lot of patients on her books that had never paid her,and was still waiting for medicare/medicaid to come up with the payments they owed her,so she had to shut her doors. The hospital she is now working in is in another state,so her medical license is now good for that state,not this one.
It is one thing,and not an easy or cheap thing,to get a medical degree and license. It is an entirely different and more difficult monster to come up with the money to own and operate an independent medical clinic.
"Family Doctors" are now a thing of the past. It is all about Medical Borgs now. Medical care distributed by a board of directors who for the most part are not even doctors,and who only care about profits.
I am sure there are exceptions to this even today,but I am not aware of any of them.