The trend continues that an increasing percentage of physicians in the U.S. are salaried as opposed to self-employed and in private practice. This trend is particularly true for younger ones. This development was discussed in a recent article (see: Latest AMA Benchmark Survey Shows Number of Physicians Employed by Health Networks Now Exceeds Those in Independent Practice) with an excerpt below:
For the first time, more doctors are employed by health networks than are in private practice.... In a press release, the AMA describes the event as “the continuation of a long-term trend that has slowly shifted the distribution of physicians away from ownership of private practices.”....According to the new release, employed physicians made up 47.4% of all patient care doctors in 2018—an increase of 6% since 2012. Meanwhile, self-employed doctors represented 45.9% of physicians in patient care—down 7% (from 53.2%) since 2012.....Physicians can be employed by other doctors in physician-owned practices, by hospitals directly, and by hospital-owned medical practices....The AMA partly attributed the increase in employed physicians to age: 70% of doctors under the age of 40 reported as employees in 2018, compared to 38.2% of doctors 55 and over who reported as employed.
So what are the possible implications of this shift, both for healthcare and for the physicians themselves? Below are as list of consequences that come immediately to my mind. You may be able to think of others:
- The shift toward the corporatization of healthcare organizations continues, sometimes referred to as the emergence of Big Medicine (see: What ‘Big Medicine’ Means for Doctors and Patients), continues apace (see: Blurring of Definition of Big Medicine; Corporatization of Healthcare). Salaried physicians working for these organizations will generally have lower salaries than those with their own practices, allowing for differences by specialty.
- Whether the merger of large systems and their corporatization of healthcare will result in lower quality is a matter of debate (see: How Big Medicine is hurting patients and putting small practices out of business). Bigger can mean both better and worse.
- I suspect that the average salaried physician will have a "better" lifestyle than colleagues in private practice, defined partly as a shorter workweek. Theoretically, this should results in a better quality of life for them.
- Physicians within large health systems who are salaried may be faced with fewer entrepreneurial opportunities than their colleagues in private practice who aspire to managerial positions. However, many large health systems are probably looking for ambitious physician to fill C-suite jobs. Such physicians could probably improve their chances for such positions by earning an MBA, perhaps on the weekends.
- Some may claim that being a salaried physician converts it into just another job, albeit one with rigorous educational requirements. I would state in rebuttal that being a physician continue to be prestigious and cite the difficulty that persists in gaining admission to a medical school (see: Why Is It So Hard to Get Into Medical School?).
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