The disappearing doctor: How mega-mergers are changing the business of medical care

The spate of mergers in the health care industry loom over doctors’ livelihoods, intensifying pressure on small practices and pushing them closer to extinction. Giant companies are already signaling a desire to tackle complex care for people with a chronic health condition like diabetes or asthma.

The spate of mergers in the health care industry loom over doctors’ livelihoods, intensifying pressure on small practices and pushing them closer to extinction. Giant companies are already signaling a desire to tackle complex care for people with a chronic health condition like diabetes or asthma. "We're evolving the retail clinic concept," says Troyen Brennan, MD, chief medical officer for CVS Health. The company hopes its proposed merger with Aetna will allow it to transform its current clinics, where a nurse practitioner might offer a flu shot, into a place where patients can have their conditions monitored. Brennan says CVS is not looking to replace patients' primary care doctors. "We're not trying to buy up an entire layer of primary care," he says. However, as people flock to retail clinics and urgent care centers, office visits to primary care doctors declined 18% from 2012 to 2016, even as visits to specialists increased, insurance data analyzed by the Health Care Cost Institute shows. The relationship between patients and doctors has also changed. Apart from true emergency situations, patients' expectations now reflect the larger culture of wanting everything now.