Doctor practices are being acquired at a rapid clip. While some physicians are choosing to sell their practices to integrated delivery systems that are provider led, the majority of doctors are selling their practices to hospitals. This should have everyone concerned. For one thing, there's ample evidence that provider productivity declines when doctors become salaried employees of hospitals. Most hospitals, including public companies like HCA Holdings, Inc. track productivity by borrowing from the RVU system that Medicare uses to set reimbursement rates. But this RVU system doesn't measure productivity, just consumption of a doctor's resources (time, effort) in performing given tasks. So it will understate the loss in productivity that occurs from these new arrangements.