Every one of Washington’s 39 counties is now designated at least a partial “health professional shortage area” by the federal government, meaning there aren’t enough doctors overall, or in certain specialties, to meet patients’ needs. Rural areas, in particular, are struggling to attract and retain enough physicians.
Medicare’s flawed reimbursement formula deserves some of the blame for this ongoing, worsening shortage. For years, Medicare’s pay for “independent” doctors unaffiliated with hospitals has been on the decline — even as it’s been rising for hospitals.
That’s forcing independent practices to make impossible decisions: lay off staff, accept buyout offers from hospital systems or even close their doors entirely.
The demise of independent practices isn’t just bad for their employees and owners. It ultimately means higher costs and worse service for patients and taxpayers. That’s why it’s so critical for Congress to fix the problem when it returns to the nation’s capital this fall.
As an independent physician practicing in Auburn, Tacoma and Puyallup, I know firsthand how difficult it can be to operate a financially sustainable medical practice. Rent, labor and other operational costs are on the rise. But Medicare reimbursement rates for physicians decreased in 2025 for the fifth year in a row. Adjusted for inflation, Medicare reimbursements to physicians have fallen by one-third since 2001.
Hospital reimbursements, meanwhile, are automatically indexed to inflation. Hospitals also charge several times more than independent physicians for the exact same exams, scans, procedures and other health care services.
As a result, many large hospital systems have a financial incentive — not to mention excess cash — to acquire independent practices or hire away their doctors. From 2019 to 2024, hospitals nationwide acquired nearly 8,000 physician practices and hired almost 75,000 physicians.
It’s the same story here in Washington. Roughly half of Evergreen State physicians are now employed by hospitals.
The structural advantages enjoyed by hospitals can be insurmountable for private practices. We’re forced to not only overcome declining reimbursement but also compete for talent with hospitals that offer above-market pay. I know of several practices that cite difficulty recruiting new physicians as the primary reason they will ultimately be forced to close or sell to a hospital.
The ramifications for patients are significant. Independent practices often deliver higher-quality and more personalized care at lower cost than large hospitals. And patients treated at smaller physician-owned practices have lower rates of preventable hospital admissions.
Failing to peg Medicare reimbursement to inflation — combined with years of real cuts in pay — will put many of these doctors out of business or force them to join larger hospitals in more populous areas. That will leave thousands of patients, especially in more rural areas, without a local, accessible source of care.
Fortunately, Washington’s congressional delegation is leading the charge to fix the problem. U.S. Rep. Kim Schrier, D-Issaquah, the first pediatrician to ever serve in Congress, is an original co-sponsor of the Medicare Patient Access and Practice Stabilization Act of 2025, which would boost Medicare pay for independent physicians to offset the cuts in recent years. The bill enjoys substantial bipartisan support — 177 members of the House back it, including a bipartisan majority of Washington’s representatives.
Rep. Schrier also co-sponsored a bill in the last Congress that would permanently fix the problem — by indexing independent physicians’ Medicare reimbursements to inflation, just as Medicare already does for hospitals and nursing homes.
If our leaders can ensure these sorts of reforms make it into this year’s must-pass spending bills, it would avert disaster for many of Washington’s smaller medical practices — and thus keep medical care accessible for vulnerable seniors and costs down for taxpayers.
