For the study, researchers examined trends in physicians' practice arrangements between 2012 and 2018 using data from AMA's Physician Practice Benchmark Surveys. The surveys included data on doctors who provide at least 20 hours of patient care weekly, practice in the United States, and who are not employed by the federal government. The latest survey, conducted in September 2018, included 3,500 physicians with a response rate of 36%.
The researchers found self-employed physicians represented 45.9% of all patient care physicians in 2018, down seven percentage points from 52.9% in 2012. In comparison, the researchers found employed physicians represented 47.4% of all patient care physicians in the country in 2018, up from 41.4% in 2012.
According to the researchers, 60.1% of employed physicians worked in practices owned by other physicians in 2018, while 26.7% worked in hospital-owned practices.
The researchers found younger physicians and female physicians were less likely than others to be self-employed. Specifically, the researchers found:
- Nearly 70% of physicians under age 40 were employed by other entities in 2018, compared with 38.2% of physicians ages 55 and older; and
- 57.6% of female physicians were employed by other entities in 2018, compared with 41.9% of male physicians.
The researchers also noted variations in practice ownership by specialty. For example, the researchers found the family practice specialty had the highest percentage of employed physicians, at 57.4%, while surgical specialties had the highest percentage of self-employed physicians, at 64.5%.
The researchers said the latest figures represent the continuation of a longer-term trend. According to the researchers, the share of self-employed physicians has declined almost continuously since 1983, when 75.8% of physicians were self-employed.
However, the researchers wrote, "[C]aution should be taken in assuming current trends will continue indefinitely."
AMA President Barbara McAneny in a release said, "Transformational change continues in the delivery of health care, and physicians are responding by re-evaluating their practice arrangements. Physicians must assess many factors and carefully determine for themselves what settings they find professionally rewarding when considering independence or employment."
According to Axios' "Vitals," acquisitions and consolidations largely have driven the increase in employed physicians, as hospitals have sought to raise their market shares. The increase in employed physicians could have an effect on health care costs, because routine visits at hospital-owned practices typically cost insurers more than visits at independent clinics, even when the services provided are identical, "Vitals" reports (Gooch, Becker's Hospital Review, 5/7; Owens, "Vitals," Axios, 5/7; Lagasse, Healthcare Finance News, 5/7; AMA Policy Research Perspective, 5/6).
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