Number of self-employed health care professionals drops 10% since 2001

The percentage of health care professionals who were self-employed declined and the gap in earnings between employed and self-employed health care professionals reversed or narrowed since 2001, according to findings recently published in JAMA Network Open.

Perspective from Clif Knight, MD

“Over the last 15 years, the health care practitioner landscape has changed significantly. There has been a shift away from self-employment, Kamyar Nasseh, PhD, and Marko Vujicic, PhD, both of the Health Policy Institute, American Dental Association, wrote. “Little is known about the gap in earnings between self-employed health care professionals and those employed by for-profit or nonprofit organizations.”

The researchers looked at American Community Survey data from 175,714 self-identified physicians (n = 99,077), pharmacists (n = 26,143), optometrists (n = 4,238), podiatrists (n =1,164), chiropractors (n = 6,076), physical therapists (n = 19,008) and dentists (n = 20,008) aged older than 30 years, who worked at least 20 hours per week and at least 40 weeks per year from 2001 to 2015.

Nasseh and Vujicic found that after controlling for age, race, residence, sex, and year, and after comparing the years 2001 to 2005, to 2011 to 2015, the weighted percentage of self-employed physicians dropped from 35.2% (95% CI, 34.4-36.1) to 24.7% (95% CI, 24.2-25.2). Also among physicians and when comparing those who were self-employed to those employed by for-profit or nonprofit organizations, the regression-adjusted earnings gap reversed from $19,679 (95% CI, 14,431-24,927) during 2001 through 2005 to –$10,623 (95% CI, –14,547 to –6,699) during 2011 through 2015.

Researchers also found from 2001 to 2015 the earnings gap also reversed among optometrists, podiatrists and pharmacists when comparing the self-employed vs. those employed by the organizations and that the regression-adjusted earnings gap narrowed among physical therapists and chiropractors when comparing the self-employed vs. those employed by the organizations.

“Information on physician specialty is not included in the [American Community Survey]. There may be wide variability among specialties in physician income. If changes over time in employment modality vary by specialty, comparisons could be biased. Because the [American Community Survey] top-codes income, trends in earnings among high earners could be masked,” Nasseh and Vujicic wrote.

“Future research is warranted to determine the driving forces behind the shift away from self-employment and the shrinking earnings gap between employed and self-employed health care professionals,” the pair concluded. – by Janel Miller

Disclosures: Neither Nasseh nor Vujicic report any relevant financial disclosures.

Perspective

Clif Knight, MD

The findings by Nasseh and Vujucic, while interesting, are not surprising. Their study did not do a breakdown of physician specialty type. The AAFP has found that 71% of our members self-report as being employed, which is a higher number than in the past. But we still have members who have switched from owning their own practice to being employed and vice versa. When self-employed physicians sell their practices to a hospital system, they certainly may have more benefits and resources at their disposal, but the trade-off is the potential loss of scheduling flexibility, autonomy and other fringes that they had when self-employed.

Some of the data Nasseh and Vujucic used suggest there will be a 13% increase in the need for all physicians from 2006 to 2026, and a 14% increase needed in family physicians for the same time period, which is consistent with what our research at the AAFP has shown. There continues to be a high demand for family physicians, and the AAFP continues to try finding ways to meet that need. That can be by increasing student interest in family medicine as a career and by making sure that additional training slots are available in family medicine. But we also must remove as many of the administrative barriers as possible so that family physicians don’t leave their specialty early to mid-career which would make the shortage worse.

On that last point, we know that the administrative burden family physicians face is extremely high, whether it be the quality requirements, the prior approval requirements, documentation guidelines and the other sorts of tasks that steal time from their patients. The AAFP works with CMS on an ongoing basis to eliminate some of those barriers.

Clif Knight, MD

senior vice president for education, AAFP

Disclosures: Knight is senior vice president for education, AAFP

Sources/Disclosures

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Source:

Nasseh K, Vujucic M. JAMA Network Open. 2018;doi:10.1001/jamanetworkopen.2018.0431.