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AMA: Number of US employed physicians exceeds self-employed physicians for first time
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Employed physicians in the United States outnumber self-employed physicians for the first time, the AMA wrote in a press release.
The association also indicated that although that statistic is indicative of a “long-term trend” that has observed physicians gradually moving away from private practice, it should not be assumed the shift in employment status is permanent.
Data from 2018 that was in the release included:
- 47.4% of patient care physicians were employed physicians.
- 45.9% of patient care physicians were self-employed.
- 54% of patient care physicians worked in physician-owned practices as either a contractor, employee or owner.
- Almost 70% of physicians aged younger than 40 years were employees.
- 38.2% of physicians aged older than 55 years were employees.
- 57.6% of female physicians were employees (34.3% were practice owners).
- 52.1% of male physicians were practice owners (41.9% were employees).
- 56.5% of physicians worked in practices with 10 or fewer physicians.
- 8% of all patient care physicians worked directly for a hospital or a practice at least partially owned by one.
In addition, and also in 2018, the highest share of practice owners was observed in the surgical subspecialties, where 64.5% were owners, followed by 53.8% of OB-GYN providers and 51.7% of internal medicine subspecialties.
On the flip side, the lowest share of practice owners was seen in the emergency medicine field, where 26.2% were owners. This specialty also had more independent contractors (27.3%) than any other field, and family practice had the highest share of employed physicians (57.4%).
“Transformational change continues in the delivery of health care and physicians are responding by reevaluating their practice arrangements,” Barbara L. McAneny, MD, AMA president, said in the release.
“Physicians must assess many factors and carefully determine for themselves what settings they find professionally rewarding when considering independence or employment.”
She added that physicians needing help making such decisions are encouraged to contact AMA for assistance.
Disclosure: McAneny is AMA president.
Perspective
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Jack M. Bert, MD
As large health care systems continue to establish control of local markets, the number of employed orthopedic surgeons compared to private-practicing orthopedic surgeons continues to increase. This has occurred out of necessity as more than 700 orthopedic surgeons complete residency and/or fellowship training annually and seek jobs in the marketplace. Private practice jobs are limited due to the market pressure of these massive health care systems and competition in urban areas is significant. Younger orthopedists tend to migrate to hospital and/or health care system employed positions due to an initial high salary which often is upward of eight to 10 times the amount that they were earning as a resident.
However, contractual agreements must be thoroughly vetted by the employed physician in order to ascertain whether future earnings are based upon work relative value units, collections, etc. Knowing the payer mix of the employee’s health care system is difficult due to the supposed “proprietary” nature of the collection process. It is almost impossible to obtain data from a hospital system or health care system to determine the potential for future earnings, and the contracts offered are extremely favorable to the hospital/health care system and potentially unfavorable to the employed surgeon. I have observed “clawback” agreements in contracts which require the employed surgeon to “pay back” salary amounts if work levels are not attained. Often, this is based upon collected amounts and if the payer mix is all Medicare and Medicaid, it can be extremely difficult to reach reasonable collections based upon billed charges.
In addition, often employed systems, as well as private practice groups, need to help you develop a referral base. Many health care systems employ their own family physicians and it is totally allowable to direct patients to a new surgeon within the system.
At our annual meeting in January, we discuss market trends and contract issues. It is critical for the young surgeon entering practice or the older surgeon wishing to change locations to understand the risks and pitfalls associated with attempting to understand the marketplace in their future job search.
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