{"id":154,"date":"2023-10-17T08:31:42","date_gmt":"2023-10-17T08:31:42","guid":{"rendered":"https:\/\/proteanmed.com\/blog\/?p=154"},"modified":"2026-07-01T11:53:34","modified_gmt":"2026-07-01T11:53:34","slug":"from-the-heart-of-texas-a-family-physicians-journey-with-dr-srinivas-rumalla","status":"publish","type":"post","link":"https:\/\/proteanmed.com\/blog\/from-the-heart-of-texas-a-family-physicians-journey-with-dr-srinivas-rumalla\/","title":{"rendered":"Why Private Practice Is Vanishing \u2014 A 25-Year Physician&#8217;s Take | The Protean Pulse Podcast"},"content":{"rendered":"\n<iframe data-testid=\"embed-iframe\" style=\"border-radius:12px\" src=\"https:\/\/open.spotify.com\/embed\/episode\/37RBOI5rh1C6NY17WP4rnQ?utm_source=generator&#038;si=e466390e4ab44c25\" width=\"100%\" height=\"352\" frameBorder=\"0\" allowfullscreen=\"\" allow=\"autoplay; clipboard-write; encrypted-media; fullscreen; picture-in-picture\" loading=\"lazy\"><\/iframe>\n\n\n\n<p>Ask most physicians what they trained for, and the answer is simple: taking care of patients. Ask them what actually eats their week, and the answer looks very different \u2014 staffing, insurance rules, and the slow disappearance of the independent practice itself.<\/p>\n\n\n\n<p>On this episode of The Protean Pulse Podcast, host Rajee Hari spoke with Dr. Srinivas Rumalla, an internal medicine physician who has been in practice since 1996. Over 25 years, he&#8217;s watched American medicine transform from a world of solo and small-group practices into one increasingly owned by corporate systems. His perspective is unusually well-rounded: he&#8217;s been a private-practice owner, a hospitalist, and a hospital co-founder.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>An uncommon path into American medicine<\/strong><\/h2>\n\n\n\n<p>Dr. Rumalla grew up in Hyderabad, in the Indian state of Andhra Pradesh, and \u2014 like many students there \u2014 had to choose his career at 17, straight out of high school with no undergraduate years in between. Medicine and engineering were the two paths considered most promising, and he chose medicine, earning a place in a state-sponsored medical school in the 1980s, when such spots were scarce.<\/p>\n\n\n\n<p>His route to the US was rare. Married to a physician who trained at LSU, he was able to complete the final nine months of his medical education at LSU Shreveport \u2014 becoming, he says, the first from his state to finish medical school in the US. It required a government order from Andhra Pradesh and approval from the Medical Council in Delhi. He still counted as a foreign medical graduate and completed the full USMLE sequence, but the early exposure to US medicine, he says, laid a foundation for everything after.<\/p>\n\n\n\n<p>He and his wife did a couples match and completed internal medicine residencies together at the University of Texas in Houston \u2014 during an era when the intern year meant 120 to 140 hours a week, before duty-hour limits existed.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>The business of medicine that no one teaches<\/strong><\/h2>\n\n\n\n<p>One of the episode&#8217;s most candid moments comes when Dr. Rumalla says plainly that physicians are not, by training, good businesspeople. Doctors are taught to believe what a patient tells them \u2014 a habit that doesn&#8217;t translate to business.<\/p>\n\n\n\n<p>Yet he ventured well beyond the exam room. In 2007, he became a founding partner of a long-term acute care hospital built from the ground up, caring for patients who needed more than two or three weeks of hospitalization. He and his partners ran it for roughly 15 years. His broader point: for physicians, strength is in numbers. Groups of doctors can build office buildings, invest in real estate, or form IPAs (independent physician associations) and participate in ACOs (accountable care organizations) that contract directly with insurers and share the savings from efficient, quality care.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Why the solo practice is disappearing<\/strong><\/h2>\n\n\n\n<p>The headline trend of the conversation is stark. Dr. Rumalla estimates that more than 60\u201370% of new physicians now begin their careers employed rather than independent. (He offers this from experience rather than a cited study.)<\/p>\n\n\n\n<p>The reason isn&#8217;t just the difficulty of seeing patients \u2014 it&#8217;s everything around it: the insurance contracts, the unpredictable payment rules, the staffing, the compliance. For a new physician, standing up a solo practice from scratch has become extraordinarily hard. His own practice survived, he says, because it&#8217;s had decades to adapt.<\/p>\n\n\n\n<p>At the same time, large players \u2014 Walgreens, CVS (which acquired Oak Street Health), and Amazon \u2014 have moved aggressively into healthcare. The logic runs through accountable care organizations: whoever controls a large volume of primary-care patients can contract directly with insurers and Medicare. And in the eyes of payers, patients &#8220;belong&#8221; to their primary care physician, not their specialists \u2014 which is exactly why corporations are so eager to acquire primary care.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What patients gain, and quietly lose<\/strong><\/h2>\n\n\n\n<p>The trade-off, Dr. Rumalla argues, is the personal touch. In his own office, the same front-desk staff have been there for 15 years. In corporate settings, staff and even physicians turn over every year or two, so patients rarely see the same face twice. He&#8217;s had patients switch to him for exactly that reason.<\/p>\n\n\n\n<p>Some patients don&#8217;t mind \u2014 they&#8217;re seen on time and get their prescriptions, and that&#8217;s enough. But others, especially older patients, come in partly for the relationship: to talk to the physician and the nurses they&#8217;ve known for years. Both models have benefits, he says; they&#8217;re just different.<\/p>\n\n\n\n<p>Rajee Hari, speaking as a patient whose own practice was acquired, noted she&#8217;d seen little change personally \u2014 but largely because of a pre-existing relationship with her provider, and she&#8217;s heard others describe the new front-desk processes as cumbersome.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>The future: more corporate, and the case for competition<\/strong><\/h2>\n\n\n\n<p>Dr. Rumalla doesn&#8217;t expect the trend to reverse. He sees fewer private physicians ahead and specialists increasingly pulled into corporate structures too. Whether that&#8217;s ultimately good for patients is, in his words, hard to say. His hope rests on competition: as long as several large systems compete, patients retain some leverage. If the market narrows to one or two systems, it becomes take-it-or-leave-it \u2014 and the patient is the one who suffers.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Advice, burnout, and staying whole<\/strong><\/h2>\n\n\n\n<p>Asked what he&#8217;d tell his 18-year-old self, Dr. Rumalla&#8217;s answer is simple: things rarely go as expected, so hope for the best and prepare for the worst. He has no regrets about the path \u2014 he sees four generations of some families and counts the gratitude of patients among the few professional rewards that are both paid and heartfelt.<\/p>\n\n\n\n<p>He&#8217;s honest, too, about balance he didn&#8217;t have early on. For the first couple of decades, private practice left little room for anything else. In recent years he&#8217;s carved out time for hiking, the gym, and friends \u2014 and his advice to newer physicians is to build that in from the start. Work is a predominant part of life, he says, but not the only part. For managing stress, he also points to physician communities \u2014 he served as president of the Indian Doctors Association of Houston in 2010 \u2014 where doctors compare notes on running a practice and simply feel less alone.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><em>The Protean Pulse Podcast features conversations on physician and APP careers, healthcare staffing, and the operational realities of medicine. Hosted by Rajee Hari, Founder &amp; CEO of Protean Med \u2014 a healthcare staffing and recruiting firm in The Woodlands, TX, specializing in locum tenens and permanent placement. Listen on Spotify: search &#8220;Protean Pulse.&#8221;<\/em><\/p>\n\n\n\n<p><em>This article is for informational and career-focused purposes only and does not constitute medical advice.<\/em><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n","protected":false},"excerpt":{"rendered":"<p>Ask most physicians what they trained for, and the answer is simple: taking care of patients. Ask them what actually eats their week, and the answer looks very different \u2014 staffing, insurance rules, and the slow disappearance of the independent practice itself. On this episode of The Protean Pulse Podcast, host Rajee Hari spoke with [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":155,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/proteanmed.com\/blog\/wp-json\/wp\/v2\/posts\/154"}],"collection":[{"href":"https:\/\/proteanmed.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/proteanmed.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/proteanmed.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/proteanmed.com\/blog\/wp-json\/wp\/v2\/comments?post=154"}],"version-history":[{"count":2,"href":"https:\/\/proteanmed.com\/blog\/wp-json\/wp\/v2\/posts\/154\/revisions"}],"predecessor-version":[{"id":734,"href":"https:\/\/proteanmed.com\/blog\/wp-json\/wp\/v2\/posts\/154\/revisions\/734"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/proteanmed.com\/blog\/wp-json\/wp\/v2\/media\/155"}],"wp:attachment":[{"href":"https:\/\/proteanmed.com\/blog\/wp-json\/wp\/v2\/media?parent=154"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/proteanmed.com\/blog\/wp-json\/wp\/v2\/categories?post=154"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/proteanmed.com\/blog\/wp-json\/wp\/v2\/tags?post=154"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}