Ballard Health’s flagship hospital, Johnson City Medical Center, has received a one-of-five star rating from the Centers for Medicare and Medicaid Services (Brett Kelman/KFF Health News)

Rural Tennessee lost hundreds of independent doctors in four years as the total number of doctors serving patients swallowed corporate consolidation and shrunk at the same time as engulfing standalone medical practices.

Between 2019 and 2024, rural Tennessee patients lost access to 362 independent physicians and 344 independent medical practices.He reports a report commissioned by the Physician Advocacy Institute. Found.

Some of those doctors simply stopped practicing in rural areas, while others became employees of the larger healthcare system.

Tennessee, like other states, has seen the integration of hospital systems that buy out competing or independent physician practices, particularly in the northeastern region of the state where Ballard Health operates as a virtual hospital monopoly for more than a million people who replace unattended healthcare. Ballads have also been purchased or folded in the practice of previously independent physicians.

Such integration raises important policy questions, the authors of the report note. These include “erosion of physician autonomy” and “higher medical costs and potential declines in quality.”

Renegotiation of transactions between Tennessee officials and Ballard reduced previous standards of quality of care as the hospital system was able to operate despite anti-monopoly rules.

“The integration of physician services under rural hospitals and business institutions raises concerns about reduced access, increased costs and potentially lower quality of care,” the report said.