Rural Tennessee is bleeding independent physicians, new report finds

Johnson City Medical Center, a flagship hospital for Ballad Health, has received a rating of one star out of five from the Centers for Medicare & Medicaid Services.(Brett Kelman/KFF Health News)

Rural Tennessee lost hundreds of independent physicians over a four-year period as the overall number of doctors serving patients shrank at the same time corporate consolidation swallowed standalone medical practices, a study from a physician advocacy group found. 

Between 2019 and 2024, patients in rural Tennessee lost access to 362 independent doctors and 344 independent medical practices, the report commissioned by the Physicians Advocacy Institute found. 

Some of those doctors simply ceased practicing in rural areas, while others became employees of larger healthcare systems. 

Tennessee, like other states, has seen consolidation of hospital systems that out-compete or buy out independent physician practices — a marked trend particularly in the state’s northeast region, where Ballad Health now operates as a virtual hospital monopoly for more than a million people with no other alternative for inpatient healthcare. Ballad has also bought out or folded in previously independent physician practices. 

Such consolidations raise important policy questions, the report’s authors note. They include the “erosion of physician autonomy,” and “higher healthcare costs and potential declines in quality.”

A renegotiation of a deal between Tennessee officials and Ballad that has allowed the hospital system to operate despite anti-monopoly rules has since lowered the previous quality of care standards the state once held system responsible for meeting.  

“Consolidation of physician services under hospitals and corporate entities in rural areas raise concerns about reduced access, rising costs and potential declines in care quality,” the report said.