Health care in Fresno mirrors nationwide trends. Throughout the nation, large health care corporations, health insurers and private equity firms are buying physician practices. Recent reports from 2024 show corporate entities and hospitals now own about 60% of medical practices and employ more than three-fourths of the 866,000 American physicians. Despite Fresno County’s high poverty rate and 51% to 54% of the population (about 500,000 people) being enrolled in Medi-Cal, Fresno is a desirable market for corporations seeking to make a profit off health care.
Health care in Fresno, and elsewhere in the US, has changed over the past decades. The practice of medicine in Fresno has historically been locally controlled, with community physicians overseeing inpatient care and maintaining close relationships with their patients, families and other providers. Internists and many family practitioners once followed their patients through all stages of care, including office visits, emergency admissions, hospital stays and discharge with follow-up in the office or clinic. Since the mid-1990s, internal medicine and family practice have shifted to a model where hospitalists handle all inpatient care, while primary care internists and family practitioners manage outpatient care. A frequently quoted number is that hospitalists currently provide inpatient hospital care for up to 80% of hospitalized patients (depending on the location) in the US.
BACKGROUND
Rising costs, increased administrative burdens and stagnant reimbursement from payors have made it difficult for independent medical practices to survive in the current economic environment. Over the past decade, in an effort to improve their profits, major nationwide health insurers, traditional health systems and corporate entities—including UnitedHealth Group (Optum), Humana, CVS Health (Aetna) and Cardinal Health—have acquired thousands of physician practices across the US for billions of dollars.
Insurance companies and the other corporate entities that acquire hospitals and medical practices prioritize profits over patients’ and physicians’ interests, sometimes acting as both the payors and the payees of insurance claims. By reducing payments, companies can increase shareholder profits. The Government Accountability Office (GAO), a federal, nonpartisan, independent legislative branch agency, published a report in September 2025 that noted physician consolidation with hospital systems generally leads to increased spending and prices for the patient and the payor.[4] The report was directed by Leslie V. Gordon, GAO’s director of health care and a career civil servant, not a political appointee.
At this time, there are three major hospital systems in Fresno—Kaiser Fresno, with 7,600 discharges per year; St. Agnes, part of the Trinity Health Network, with 27,000 discharges per year; and Community Health System (CHS), with almost 40,000 discharges per year. CHS is the nonprofit parent of Community Medical Centers (CMC) and operates the largest hospital network in the Central Valley. Community Regional Medical Center (CRMC) has the second-highest number of discharges of all the hospitals in the state of California.
The hospitalist model of care became prevalent in the mid-1990s. At that time, local hospitalist groups began managing inpatient care under contractual agreements with St. Agnes and CMC hospitals. Founded in 1996, Santé Community Physicians provided physician care for many Central Valley hospitals, including CMC hospitals. Santé Health System, a health care management services organization (MSO) based in Fresno, handles the administrative, operational and business tasks for more than 1,900 independent medical providers in the Central Valley.
After 25 years, Santé’s contract to provide hospitalists for CMC ended acrimoniously in 2021. Community Hospitalist Physician Group (CHPG) formed in 2022 and contracted with CHS to provide hospital care for patients at CMC facilities—CRMC, Clovis and Fresno Heart & Surgical Hospital. CHPG had roughly 120–130 physicians, many of them former Santé inpatient physicians. The group handled inpatient services, often employing a seven-days-on, seven-days-off rotation, with about 30% of the physicians commuting from outside the Fresno area.
ON SEPTEMBER 1, 2026, LOCAL HOSPITALIST LEADERSHIP IN FRESNO ENDS
In December 2024, St. Agnes, the other local nonprofit hospital, bitterly ended its contract with a local Fresno hospitalist group. Vituity, a national, physician-owned and physician-led organization providing medical staffing for hospitals, was contracted to provide care for hospitalized patients at St. Agnes. Vituity employs about 6,000 doctors and other advanced health care providers at about 900 facilities nationwide.
In May 2026, CHS announced that CHPG’s contract would be terminated in favor of a contract with Sound Physicians. On September 1, 2026, Sound Physicians, a national, private-equity-backed medical staffing company, will take over inpatient medical care at the CMC facilities—CRMC, Clovis Community Medical Center and Fresno Heart & Surgical Hospital. Sound Physicians will not be assuming care of the patients on the training services at CRMC. As mentioned above, this transition reflects nationwide trends in corporate medicine and marks a turning point for how hospital care will be delivered in the Central Valley.
WHO IS SOUND PHYSICIANS?
Sound Physicians was founded in 2001 and has since expanded into a multi-specialty, hospitalist-focused organization serving more than 450 hospitals in 45 states. In 2018, a majority stake in the company was acquired by a private equity consortium led by Summit Partners and OptumHealth, a subsidiary of UnitedHealth Group, in a $2.15–$2.2 billion deal. UnitedHealth Group is the largest health care company in the world by revenue. It operates two main business segments. UnitedHealthcare sells health plans to individuals, employers and government programs such as Medicare and Medicaid. Optum provides pharmacy services, data analytics and technology, and it directly employs or partners with tens of thousands of physicians.
The company model for Sound Physicians emphasizes cost efficiency and revenue optimization. Sound Physicians frequently wins corporate hospital contracts by undercutting the prices of existing local doctor groups. When taking over staffing of a hospital, Sound Physicians frequently staffs with fewer doctors per shift, supplements them with nurse practitioners and physician assistants and offers lower physician salaries and higher patient loads. For the corporate stakeholders, this approach maximizes profitability; for local physicians and patients, it raises serious concerns about safety, continuity and quality of care. Sound Physicians’ private-equity-backed business model has faced intense and widespread criticism for destabilizing local medical ecosystems. Local physicians leave the area and look for positions elsewhere.
It has been difficult to reach Sound Physicians, CMC executives or CHPG about this upcoming change. Outgoing CHPG physicians who responded, and who asked for anonymity for fear of retribution, have expressed concerns about the transition from a local hospitalist group to Sound Physicians. Some of the current CHPG physicians were offered positions with Sound Physicians, but the salary, benefits and working conditions were significantly below their current contract. Some of the concerns expressed by CHPG physicians included:
1. Patient Safety and Continuity of Care: These are the most acute problems. The handoff of patients between hospitalist teams is a high-risk procedure because of the potential loss of information, known as a “voltage drop.” Local physicians fear that doctors unfamiliar with Fresno’s outpatient network will disrupt follow-up care and increase the potential for medical errors. This is especially worrisome since CMC did not arrange a process for the transition of care or respond to CHPG’s questions about how the transfer of patients was to occur.
2. Staffing Shortages and Burnout: Fresno County faces a physician shortage.[14] CHPG relied on 30–40 doctors commuting from outside the Valley to fill weeklong rotations. The Society of Hospital Medicine does not have an official position on daily patient loads, but many hospitalists recommend 12–15 patients per service as sustainable. Sustained periods of more than 20 patients a day increase the risk of burnout, which is associated with decreased quality of care and patient satisfaction.[15] The Sound Physicians model uses fewer physicians and hires nurse practitioners (NPs) and physician assistants (PAs) to fill the doctor deficit. In addition to questions of quality from NPs and PAs, physicians will still have heavier patient loads, accelerating burnout.
3. Loss of Local Control: The dissolution of CHPG signifies a shift away from local physician governance to a national corporate entity whose priorities may not align with the needs of the local medical community. A national corporation’s “one size fits all” approach will not bring physicians who understand the local health care community and its providers. This will be exacerbated by the use of temporary “locum tenens” clinicians who lack local knowledge.
The transition to Sound Physicians signals a fundamental change in the delivery of hospital medicine in Fresno. Patients admitted to CRMC, Clovis or Fresno Heart & Surgical will now be treated by corporate hospitalists instead of local physicians who have established community ties. Follow-up care may be harder to coordinate, and incoming physicians may not have the same long-term investment in the Fresno community or the Central Valley as those physicians who have roots in the community.
This shift from local physicians to staffing by national organizations reflects the change that is occurring nationally. St. Agnes and CMC, both major hospitals, are now managed by national staffing firms—one backed by private equity and the other physician-owned—effectively ending the era of locally controlled inpatient care. No longer will hospitalists be rooted in the community, providing continuity, familiarity and local accountability. This transition, made in the name of efficiency and quality but more importantly in the pursuit of profit, facilitates private-equity-backed corporations’ domination of hospital medicine locally and nationally. This shift will likely have detrimental effects on patient well-being and the local medical community.
[insert: CommunityHospital.jpg] Community Regional Medical Center in Fresno. Photo by Peter Maiden
