“For the first time in the United States, employed physicians outnumber self-employed physicians, according to a newly updated study on physician practice arrangements by the American Medical Association (AMA). This milestone marks the continuation of a long-term trend that has slowly shifted the distribution of physicians away from ownership of private practices,” the Chicago-based association noted, in a press release published on May 8.
According to the AMA, “Employed physicians were 47.4 percent of all patient care physicians in 2018, up 6 percentage points since 2012. In contrast, self-employed physicians were 45.9 percent of all patient care physicians in 2018, down 7 percentage points since 2012. Changes of this magnitude are not unprecedented. Older AMA surveys show the share of self-employed physicians fell 14 percentage points during a six-year span between 1988 and 1994.” In fact, the press release stated, “Given the rate of change in the early 1990s, it appeared a point was imminent when employed physicians would outnumber self-employed physicians, but the shift took much longer than anticipated. The AMA’s research notes this example and suggests ‘caution should be taken in assuming current trends will continue indefinitely.’”
Meanwhile, among those physicians who are now employed staff members, the AMA study found that 54 percent worked in physician-owned practices “either as an owner, employee, or contractor. Although this share fell from 60.1 percent in 2012, the trend away from physician-owned practice appears to be slowing since more than half of the shift occurred between 2012 and 2014,” the study further found.
“Concurrently, there was an increase in the share of physicians working directly for a hospital or in a practice at least partly owned by a hospital. Physicians working directly for a hospital were 8.0 percent of all patient care physicians, an increase from 5.6% in 2012. Physicians in hospital-owned practices were 26.7 percent of all patient care physicians, an increase from 23.4 percent in 2012. In the aggregate, 34.7 percent of physicians worked either directly for a hospital or in a practice at least partly owned by a hospital in 2018, up from 29.0 percent in 2012,” the press release noted. In addition, it noted, “Younger physicians and women physicians are more likely to be employed. Nearly 70 percent of physicians under age 40 were employees in 2018, compared to 38.2 percent of physicians age 55 and over. Among female physicians, more were employees than practice owners (57.6 percent vs. 34.3 percent). The reverse is true for male physicians, more were practice owners than employees (52.1 percent vs. 41.9 percent).”
These data points were taken from a report published by the AMA and called a “Policy Research Perspective (PRP), which was prepared for the association by Carol K. Kane, Ph.D. In her introduction to the report, Dr. Kane wrote, “Using data from the American Medical Association’s (AMA’s) Physician Practice Benchmark Surveys, this Policy Research Perspective (PRP) describes the practice arrangements of physicians between 2012 and 2018. The Benchmark Surveys include physicians who provide at least 20 hours of patient care per week, are not employed by the federal government, and practice in one of the 50 states or the District of Columbia. As discussed in a previous report on this topic (Kane, 2017), 2016 was the first year in which less than half of practicing physicians (47.1 percent) had an ownership stake in their practice,” Kane notes. “With this report a new milestone has been reached—2018 marked the first year in which there were fewer physician owners (45.9 percent) than employees (47.4 percent).”
Meanwhile, Kane notes in the AMA report, “While these two events are notable, they reflect, as this PRP will discuss, the continuation of a longer-term trend. The Benchmark Surveys also indicate that the distribution of physicians continues to slowly shift from practices that are very small in size to those that are very large. Between 2012 and 2018 the percentage of physicians in practices with 10 or fewer physicians dropped from 61.4 percent to 56.5 percent with much of that change driven by a shift away from solo practice.”
The report notes that there is a huge range of different situations involved, depending on medical specialty. Kane reports that “As found in prior research, there were differences in practice arrangements across physician specialties. For employment status, ownership was most common among physicians in surgical subspecialties (64.5 percent) and least common among physicians in emergency medicine (26.2 percent). In that latter specialty, more than one-quarter of physicians were independent contractors, a share that was more than 10 percentage points higher than that of any other specialty.”
