The Shifting Environment of Physician Employment

As the U.S. continues to prepare for implementation of national health care reform, hospitals have rapidly begun hiring more physicians and acquiring physician practices.

According to a recent article in the New England Journal of Medicine, more than half of practicing U.S. physicians is now employed by hospitals or integrated delivery systems, a trend fueled by the intended creation of accountable care organizations (ACOs) and the prospect of more risk-based payment approaches.

A recent survey by the Medical Group Management Association shows a nearly 75 percent increase in the number of active doctors employed by hospitals since 2000, and recent hospital announcements suggest this trend is accelerating.

With the changing paradigm of health care, the Massachusetts Medical Society conducted an email survey to Massachusetts physicians in order to learn more about the current practice environment in Massachusetts as it relates to employed physicians or physicians considering moving to an employed position.  

The email survey was sent to physician members and non-members in October 2012. Of those who responded to the survey, 60% were employed, 38% were self employed and 2% were self employed but considering an employed position.

Employed physicians or physicians considering moving to an employed position were asked to indicate how important is it for the MMS to help employed physicians in the following areas (Figure 1)? The following chart provides a ranking by percentage of physicians who said the following topics were "very important."

Employed physicians or physicians considering moving to an employed position were also asked to list the three most critical things MMS should be doing to assist physicians who are employed by a hospital or medical group. The following includes the priorities listed by the majority of respondents:

• Tort and liability reform
• CME
• Advocate for physician autonomy
• Advocate for standardized credentialing to ease transition
• Advocate for higher reimbursement 

In order to understand why physicians choose employed positions instead of private practice, the MMS asked employed physicians or physicians considering moving to an employed position what factors influenced their decision to accept an employed position. The most common reasons were: 

• Stability
• Cost and regulations of running a private practice
• Academic setting
• Not wanting business/administrative responsibilities
• Hours are more predictable

All respondents who answered the survey were asked their opinion on the benefits of an employed position. Many of the responses were similar to the answers given in the previous question about factors that influence a person to accept an employed position. The most common responses were:

• Steady hours
• Job security
• Not having to deal with business/administrative tasks
• Not having to deal directly with insurance companies
• More personal time 

Lastly, all respondents were asked their opinion regarding the challenges of an employed physician. The following includes the challenges listed by the majority of respondents: 

• Loss of autonomy
• Lack of control over work environment
• Ever increasing pressure for clinical productivity
• Maintaining the doctor-patient relationship
• Loss of focus on clinical care because of increased financial pressure at many institutions