---
title: "Lawrence Casalino on how consolidation makes physicians feel interchangeable"
id: "news-news-medical-economics-864361ada5faa5764d46fc5f"
canonical_url: "https://medichelpline.com/news/news-news-medical-economics-864361ada5faa5764d46fc5f"
content_type: "medical_news_article"
category: "Public Health"
source_name: "Medical Economics"
source_url: "https://www.medicaleconomics.com/view/the-interchangeable-physician-with-lawrence-casalino-m-d-"
published_at: "2026-09-03T09:30:00.000Z"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Lawrence Casalino on how consolidation makes physicians feel interchangeable
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- **Canonical URL:** https://medichelpline.com/news/news-news-medical-economics-864361ada5faa5764d46fc5f
- **Category:** [Public Health](https://medichelpline.com/news/public-health.md)
- **Reporting Source:** Medical Economics
- **Original Source URL:** [Read Original Article](https://www.medicaleconomics.com/view/the-interchangeable-physician-with-lawrence-casalino-m-d-)
- **Published At:** 2026-09-03T09:30:00.000Z
## Executive Summary & Key Highlights
- Lawrence Casalino, M.D., Ph.D., M.P.H., argues that health care consolidation is causing **physicians** to be treated as **interchangeable** parts, with harm appearing in areas not captured by standard quality measures. - Casalino, a professor at Weill Cornell Medicine and founding director of the Center for Physician Practice and Leadership, spoke with Medical Economics Senior Editor Richard Payerchin; the conversation was recorded in spring 2026. - He identifies five forces pushing doctors out of **independent practice**: weak negotiating leverage with payers, growing administrative burdens since 1980, costs and support needs for EHRs, policy uncertainty, and changing expectations of newer physicians. - Casalino explains why administrative relief and higher payment rates could help primary care but expresses doubt that independent practices will gain the leverage needed to obtain them. - His recent New England Journal of Medicine essay argues large organizations tend to treat employees as interchangeable; the negative effects first show up in the aspects of care that are not measured at scale, such as diagnostic timeliness and long-term patient trust. - The episode covers MedPAC (the Medicare Payment Advisory Commission), Casalino’s 20 years in primary care and six years on MedPAC, research on physician altruism, and a proposed test for policymakers: whether policies make staff feel more like widgets or less. - The podcast includes practical segments such as a brief practice management minute from Keith Reynolds and timestamps for topic navigation; references to the current year reflect spring 2026 recording timing. - Episode transcript and timestamps were produced using AI tools; the interview was presented by Austin Littrell with contributions from Richard Payerchin and fact-checking by Keith A. Reynolds and Ron Panarotti.
## In-Depth Reporting & Editorial Analysis
## Consolidation and the rise of the “interchangeable physician” In a spring 2026 conversation with Medical Economics editors, Lawrence Casalino, M.D., Ph.D., M.P.H., laid out a concise argument: as medicine consolidates, health systems increasingly treat **physicians** as interchangeable units. Casalino said the consequences appear first in parts of care that standard quality programs do not measure — for example, the speed and accuracy of diagnosis, long-term patient trust built over years, and the nuanced judgment that directs patients to the right specialist. Casalino is a professor of population health sciences at Weill Cornell Medicine and founding director of the Center for Physician Practice and Leadership, a center funded by The Physicians Foundation. He spent 20 years practicing primary care and six years serving on the Medicare Payment Advisory Commission (MedPAC). Those experiences frame his concerns about how structural and market pressures shape physician practice today. ## Five forces squeezing independent practice Casalino identifies five distinct forces pushing clinicians away from independent practice and into larger organizations: - Lack of negotiating leverage with payers: small practices face take-it-or-leave-it contracts that limit their bargaining power. - Administrative burden growth: paperwork and other administrative tasks that were minimal when Casalino began clinical work in 1980 have expanded dramatically. - Electronic health record (EHR) costs and support needs: purchasing and maintaining EHR systems impose financial and operational strains on small practices. - Policy uncertainty: shifting policy environments make long-term planning difficult for independent clinicians. - Changing expectations of new physicians: those coming out of training today expect different work–life arrangements than prior generations, affecting practice models. These forces interact, Casalino says, making it harder for small practices to survive and harder for independent clinicians to secure the systemic changes they say would help primary care. ## What would help primary care — and why it may be out of reach During the interview, Casalino said two practical levers could improve primary care: reducing administrative burdens and increasing payment rates. He noted, however, that independent practices likely lack the leverage needed to win such changes from payers or policymakers. He explained this skepticism in light of market consolidation and the bargaining dynamics facing small practices. Casalino’s description of what patients lose as consolidation proceeds included a concrete analogy: comparing a trusted physician referral to the way a car mechanic might recommend a specialty shop. When practices consolidate, that personal judgment can be lost or diluted, and the continuity that fosters trust can erode. ## The measurement gap: what quality programs miss A central theme in Casalino’s recent New England Journal of Medicine essay — discussed on the podcast — is the gap between measurable quality metrics and the unmeasured dimensions of clinical performance. Standard quality programs can capture some process and outcome metrics at scale, but they do not measure many aspects of care that matter to patient outcomes and experience, such as: - The timeliness and correctness of a diagnosis. - The cumulative trust developed between a patient and a clinician over years. - Subtle clinical judgments about referrals and care coordination. Because these dimensions are hard to quantify at scale, they do not translate into financial incentives or measurable performance indicators. Casalino argues that when organizations prioritize what can be measured, the unmeasured but essential aspects of care rely increasingly on clinicians’ **professionalism** and altruism. ## Professionalism, altruism and corporate pressures Casalino discussed his research finding that physicians are, on average, more altruistic than the general population. He warned that the corporatization of medical practice can undermine the **professionalism** that the health system depends on but does not always acknowledge. As organizations grow, they face incentives and operational constraints that can encourage standardized roles and processes — which, in turn, risk reducing clinicians to interchangeable contributors rather than recognized professionals with discretion. To help policymakers evaluate proposed reforms, Casalino offered a simple test: would the policy make clinicians and staff feel more like widgets or less? He suggested that this experiential measure — how a policy affects the day-to-day sense of professional agency — should factor into policymaking discussions. ## Inside MedPAC and the policy timeline Casalino described his time on MedPAC, noting the commission’s bipartisan standing and the often slow pace at which Congress acts on MedPAC recommendations. He described the commission as a place that examines Medicare payment and delivery issues but emphasized that translating recommendations into legislative or regulatory change can take time. ## Episode structure and additional segments The Medical Economics episode was hosted by Austin Littrell, with Richard Payerchin conducting much of the interview. The conversation included a short practice-management segment — the P2 Management Minute — in which Keith Reynolds offered practice tips and invited listener contributions. The episode was fact-checked by Keith A. Reynolds and Ron Panarotti, and the transcript and episode timestamps were produced using AI tools. A full run-through of topics is available via episode timestamps, beginning with a cold open on what happens when physicians feel interchangeable, through discussions of Casalino’s path from community organizing to medicine, the five forces confronting independent practice, what could help primary care, and the New England Journal of Medicine essay’s ideas about measurement and professionalism. The conversation closes with a practical test for policymakers and final remarks. ## What’s next Casalino’s analysis points toward two clear arenas for further attention: policy changes that reduce administrative burdens and payment reforms that better support primary care, and renewed attention to how large organizations structure roles and incentives so they do not erode unmeasured yet essential elements of care. He remains skeptical that independent practices, on their own, will regain sufficient leverage to secure major changes. Listeners and readers interested in the full discussion can find the Medical Economics episode referenced here for the complete interview and timestamps. Related Medical Economics coverage includes recent episodes and articles on malpractice rates, physician-owned hospitals, prior authorization, and other practice management topics.
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