Independence vs. Employment for Physicians

Posted by Continuum on Mar 21, 2017 11:01:00 AM

Is employment really the answer?

Hospital employment, with its promises of financial security, feAsian male doctor smiling.jpgwer administrative duties, and more stable working hours offer a strong case for physicians.  From 2007 to 2016, the number of independent physicians has decreased by 28 percent.1,2 Many physicians have opted for employment within a large health organization because it appears more appealing than fighting to maintain an independent practice; but the number of physicians pushing for independence may be on the rise.

This shift is being triggered as physicians find those promises aren’t always grounded in reality. Physicians feel that an employed position will require less administrative tasks and thereby provide more time to spend with patients. Yet administrative duties are inescapable. Most physicians are still required to maintain quality of care reporting and accurate EHR entries, whether they are independent or employed.

Similarly, some physicians believe that employment with a large organization will allow for greater influence within the healthcare environment. Instead, employed physicians frequently contend with multiple layers of authority and red tape before decisions can be reached, and 45 percent of employed physicians feel they have limited influence within their hospital.3 The allure of autonomy and power of decision making present in private practice is driving a shift back to independence.

Benefits and Challenges of Independence

Though there is often higher cost and risk associated with maintaining a small or solo practice, many independent physicians feel the ability to give direction on critical decisions is invaluable. Running a private practice allows physicians to see direct results when patients benefit from their input and care. Shrewd and effective decision making also gives small practices an edge as they adapt and restructure to face our value-based healthcare system.

Nevertheless, when running an independent practice, physicians must also manage financial and administrative tasks, oversee employees, and keep abreast of technological advances in the field. These physicians are increasingly looking to outside partners who can enable their success through best practices and technology that empower heightened financial performance and improved clinical outcomes.

Though both employed and independent physicians face benefits and challenges, only 40 percent of physicians who transitioned to employment consider themselves happy with their choice. Some groups who opted for employment found that losing control over hiring staff and day-to-day procedures caused tension within their new employment model. Conversely, 71 percent of physicians who left employment for independence are pleased they made the switch.4 Yet, despite the number of physicians who are happy to maintain their independence, only 33 percent of physicians identified as independent practice owners in 2016.2

What does this mean for patients?

Each day, employed physicians attend to 1.7 fewer patients than their independent counterparts, forcing a large number of patients to seek medical advice from a small portion of independent physicians every year.5 With advances in EHR and telehealth technology, both employed and independent physicians aim to offer meaningful visits and efficient access for all patients, but the demand on physicians to provide quality care is ever-increasing.

The number one priority for all healthcare providers is patient health. In our advancing healthcare environment, patients expect greater continuity, accessibility, and transparency. Today’s independent physicians have maintained their practices throughout the shifting healthcare environment, but challenges lie ahead. To remain autonomous and provide the best possible care for patients, independent physicians may want to consider easing financial or administrative burdens by working with an outside partner focused on performance success.

New Data on Physician Practice Arrangements: Private Practice Remains Strong Despite Shifts Toward Hospital Employment 
2016 Survey of America's Physicians: Practice Patterns and Perspectives
Medscape Employed Doctors Report 2015
Medscape Employed Doctors Report 2016
The Physician Employment Trend: What You Need to Know

Topics: independent physician practice, independent physician, hospital employment

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