Where Are the Doctors Who Actually Manage Chronic Illness?

A new federal Healthcare Advisory Committee has been announced to guide policy for

Medicare, Medicaid, and other major health programs. Its mission is ambitious: improve outcomes, modernize care, and address the growing burden of chronic disease. But there is a glaring omission. Not one independent, private practice physician, someone who manages chronic illness in the community every day, is represented. That is striking because at least one-quarter of all physicians in the United States, roughly 250,000 doctors, practice in independent or small-group settings.

After more than 30 years practicing neurology in an independent setting, I was surprised to see that absence. My patients are Medicare beneficiaries with complex, chronic conditions including multiple sclerosis, epilepsy, dementia, and Parkinson’s disease. These illnesses require continuous management, coordination across providers, and long-term relationships with patients and families. Managing chronic illness today is increasingly complicated by administrative burdens such as prior authorizations, precertification requirements, and restrictions imposed by Medicare Advantage plans. These burdens are so extensive that more and more independent physicians are unable to see Medicare Advantage patients at all.

Independent physicians operate within a very different reality from large health systems. We manage these challenges without layers of administrative support. We are often the only consistent point of contact for patients over years. We see directly how policy decisions affect care on the ground. Yet current Medicare payment structures favor hospital-employed physicians and large health systems, reimbursing them significantly more than independent doctors for the same services. Adjusted for inflation, reimbursement to physicians has declined by more than 30 percent over the past 25 years, further threatening the viability of independent private practices.

Federal advisory committees are intended to reflect a balance of perspectives relevant to the issues they address. In healthcare, that balance is often interpreted broadly to include clinicians, administrators, and policy experts. But not all clinical perspectives are interchangeable. Independent, community-based physicians represent a distinct model of care delivery defined by continuity, longitudinal management, and direct accountability to patients rather than institutions. When that perspective is absent, it is not simply a missing voice; it is a missing understanding of how care is actually delivered for millions of Medicare beneficiaries.

The advisory committee includes accomplished physicians, executives, and policy

experts. Their expertise is valuable, but without representation from independent,

community-based physicians, an important dimension of care is missing. Policies

developed without frontline input often fail in practice. Requirements such as prior

authorizations and documentation mandates consume time that should be spent with

patients. Payment disparities continue to push physicians out of independent practice and into large systems. And as more physicians step away from Medicare Advantage plans because of administrative burden, access to care for many patients is quietly shrinking.

Healthcare reform works best when it reflects the full spectrum of care delivery. That

includes not only large systems, but also the physicians working outside them. Twenty-five years ago, roughly two-thirds of physicians practiced independently. Today, that number has fallen sharply, and by some estimates, truly independent physicians may represent closer to one-quarter of the workforce when large consolidated groups and private equity backed practices are excluded. If Medicare does not recognize the pressures driving this shift, particularly for those managing chronic illness in the community, independent practice may continue to disappear. That would not simply be a loss for physicians. It would be a loss for patients who depend on continuity, access, and long-term relationships in their care.