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Sarah Krizanic, Practice Manager, Medic Management Group, LLC

The Physician Dilemma: Private Practice or Hospital Employee?

By Sarah Krizanic
Practice Manager
Medic Management Group, LLC

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Original Publish Date: December 6, 2016

A few years ago it may have seemed that Private Practice was a thing of the past, that all physicians would eventually close up their practices and become hospital employed physicians, and many of them did. What wasn’t expected was how many physicians stuck it out and refused to follow the trend. Another surprise came a few years later when providers started leaving the hospitals and returning to private practice. In fact, in 2015 the AMA reported that 60.7% of physicians were employed by smaller practices consisting of 10 or fewer physicians. They also reported that in 2014 56.8% of physicians were employed by practices owned solely by physicians, with no hospital ownership of any kind. So what changed? Several factors seems to have caused this shift including: gender, age, job satisfaction, and work-life balance.

Medscape took a closer look at these factors, and made some surprising discoveries, after they conducted a survey of almost 5000 physicians of mixed specialties. One thing they found was that there was a higher rate of employed female physicians than males. Of the females that responded to the survey, 82% reported being employed in comparison 78% of males that responded to the same survey. Age also seems to be a factor in the decision to become an employed physician. For employed physicians, 23% were 40 or younger, 40% were 40-54 years old, and 36% were 55 or over. As for self-employed physicians, 11% were 40 or younger, 44% were 40-54, and 45% were 55 or over.

Employed physicians find job satisfaction in not having to worry about running a practice, less administrative responsibility, and steady cash flow, but find that they miss the involvement in the decision making process, have less control over their schedules, and face limited income potential. Although most physicians made the decision to become employed to achieve financial stability, only 45% reported being satisfied with their salaries after switching and 29% reported being unsatisfied with their salaries after switching. Medscape also found that women are less satisfied being employed than self-employed. While 51% of employed females reported that they were satisfied, or very satisfied, with their job, 62% of self-employed females reported being satisfied, or very satisfied, with their job. They also found that only 55% of employed female physicians are satisfied with their level of autonomy as an employed physician.

When the physicians were asked about their work-life balance, 54% of physicians reported that the balance had improved, 26% reported that it stayed the same, and 19% reported that it actually got worse. The reason for the dissatisfaction with their work-life balance after becoming an employed physician could be due to the ability to have more flexible hours as a self-employed physician, whereas employed physicians tend to have a more structured schedule. Of the employed physicians, 22% see 11-15 patients per day, 27% reported seeing 16-20 patients and 22% see 21-15 patients per day.

But the real question is, who’s happier? It appears that self-employed physicians tend to be happier than employed physicians. 63% of self-employed physicians reported being satisfied with their work, whereas employed physicians only ranked at 55%. To build on that, both males and females ranked a 62% satisfaction rate with their jobs as self-employed physicians, as opposed to 58% of employed males and 51% of employed females being satisfied. Also, only 40% of employed physicians stated their satisfaction improved when they became employed in comparison to 71% for self-employed physicians. It should also be noted that 57% of currently employed physicians, who were previously self-employed, would recommend employment and only 29% self-employed, previously employed, physicians would recommend becoming an employed physician.

Despite the results of the survey, 47% of physicians that participated stated they would remain in their current employment arrangement for at least the next year or longer and 34% stated they plan on staying in their current employment arrangement during the next year, but are considering a change in the future. With all of that being said, employed and self-employed physicians tied at 81% when asked about their sense of pride and accomplishment. Overall, the results for satisfaction with their career as a physician nearly mirrored. 72% of employed physicians reported being satisfied with their career versus 73% of self-employed, 20% of employed physicians reported being neutral where as 17% of self-employed physicians reported being neutral on the topic, and 8% of employed-physicians said they were dissatisfied with their career as a physician in comparison to 10% of self-employed physicians.

In the end, the physician has to decide what fits his or her lifestyle and determine what tradeoffs they are willing to make in order to achieve satisfaction in their careers and personal lives. There is no right or wrong answer. Therefore, I think there will always be a healthy mix of employed and self-employed physicians.

Sarah is a Practice Manager at Medic Management Group, LLC. She earned her Bachelor’s degree in Health Care Administration at Kent State University and graduated magna cum laude. Since then she has worked exclusively with private practice physicians.

Sarah joined Medic Management Group in June 2015 and currently provides administrative oversight to a small practice, assists with new practice start-ups, and other client and corporate projects. She also provides clients with human resource management, payroll, and acts a supporting manager for other MMG Practice Administrators.