Employed doctors appreciate many of the advantages of not having to run a business; self-employed physicians say they are happy that they can run their own show and don't have to play politics or follow policies they disagree with. But many doctors still wonder whether they'd be happier and better off in a different situation. Some have made the switch; did they think it was worth it? Medscape surveyed almost 5000 physicians to find out whether they feel they'd be better off as an employee or as a partner or solo practitioner. See what they had to say. Women make up 33% of the physician workforce, and a larger percentage of them are employed than are men. Some female physicians are attracted to the "work-life balance" that is more often afforded by employment—predictable hours, often without call responsibilities, according to Greg Mertz, managing director of Physician Strategies Group, a performance-improvement consultancy for physicians in hospital-affiliated and private settings, located in Virginia Beach, Virginia. You can't generalize about female physicians, but quite a few care more strongly about work-life balance than do men, says Marc Mertz, vice president of GE Healthcare Camden Group in El Segundo, California, involved in medical group development and physician-hospital alignment strategies. (He is the son of Greg Mertz, but they have separate careers across the country from each other.) Younger physicians overwhelmingly prefer employment. Physicians under age 40 are twice as likely to be employed than self-employed (23% vs 11%). However, almost 8 in 10 employed physicians (78%) are age 40 or older, and these older physicians' share of the employment pie has risen by 8 points since 2014. Older physicians often use employment as a step toward retirement, Greg Mertz says. "Since private practices can no longer be sold for large sums of money, physicians nearing retirement often shut them down and shift to employment, where they can get better retirement benefits," he says. "I've seen a lot of older primary care physicians selling their practices to hospitals as they approach retirement," Marc Mertz says. The hospital recruits a younger physician to work with the older physician and ultimately replace him, he says. Almost twice as many physicians have switched from self-employment to employment than the other way around. However, this back-and-forth movement has been slowing down. The rates of physicians switching were half the corresponding rates in the 2014 survey. "In many markets, physicians who wanted to sell have mostly done so," Marc Mertz says. "Some markets are still hot, but generally the activity seems to be slowing down. Also, physicians and hospitals are looking at alternative alignment models that don't lead to employment." There are reasons why the move to self-employed status has less volume than the other way, Greg Mertz says. "While it's easy to close a practice and become an employee, getting out of an employment contract often means moving to another area due to anti-competitive clauses in these contracts. It's also expensive and time-consuming to start up a practice from scratch." The traditional pattern was for employed physicians to work in hospitals and large groups, while self-employed physicians worked in practices. But those distinctions are blurring. According to the survey, 19% of self-employed physicians work in a hospital, and 36% of employed physicians are office-based. Up to about 15% of employed and self-employed physicians work in a variety of settings that include academic, research, military, government, and other. Hospital-based doctors such as hospitalists and anesthesiologists can be direct employees of the hospital or part of independent groups that contract with the organization, Marc Mertz says. But even when self-employed, "they are part of the hospital culture and they're very clearly aligned with the goals of the hospital," he says. Lately there has been a modest trend of hospitals moving from contractual relationships to direct employment of physicians. According to the survey, a larger proportion of employed physicians (32%) are working in hospitals compared with in 2014 (25%). Financial security was the most cited reason for employment, noted by just over one third (36%) of employed physicians. Meanwhile, only 15% cited fewer administrative responsibilities, about half the rate in the 2014 survey (29%). Employed physicians actually have a lot of administrative duties, Marc Mertz says. Although they don't have to manage an office, "they still have to deal with referrals, quality reporting, and EHR [electronic health record] entry," he says. "And there's more data reporting going on in a healthcare system than in private practices." Thirteen percent of employed physicians said it wasn't their choice to be employed. Greg Mertz says that either they were forced to sell their practices because they were losing money, or they were outvoted by fellow shareholders in the practice who decided to sell to a hospital. Doctors' favorite aspect of employment is not having to run a practice. This was cited by more than half of respondents, outpolling every other category, including work-life balance and more regular hours. "Doctors are happy to turn many of the functions of running a practice over to an organization," Marc Mertz says. "These include billing, IT investment, and, perhaps most of all, the hiring, firing, and disciplining of staff." Still, "employed physicians do like the regular hours," Marc Mertz says. He notes that hospitalists seem to be the happiest with work-life balance. They are shift-based and take no call. Even though they enjoy regular hours, Greg Mertz says employed physicians still have to work hard to meet the productivity goals often tied to their salaries. "An employed physician often doesn't have the option of working less like one does in private practice," he says. When asked what they didn't like about their work, employed physicians often cited lack of control and autonomy. These categories included limited influence in decision-making (cited by 35%), less control over work and their schedules (28%), too many rules (26%), being "bossed around" (22%), and less autonomy (20%). One reason for lack of autonomy is that hospitals have been standardizing operations, Greg Mertz says. As a result, the modern healthcare organization has a plethora of rules and multilayered hierarchies that can get in the way of efficient patient care, he says. "These organizations have a variety of structures, policies, and procedures that physicians are expected to follow," Marc Mertz says. "Employed physicians often have to work extra hours at the end of the day to document, close EHR records and orders, and fill out paperwork," he says. He adds that employed physicians in hospitals often have to join committees and attend a lot of meetings, but this is less of a problem for employed physicians practicing in the community. Somewhat more self-employed physicians than employed physicians—63% versus 55%—are satisfied with their work. Why are self-employed physicians more apt to be happy? "They are willing to risk losing some income in exchange for more control," Greg Mertz says. In a private practice, "when the owner speaks, things happen," Marc Mertz says. "But when an employed doctor speaks, it has less effect." However, satisfaction rates for both groups have plummeted since 2014, especially for employed physicians. The rate for self-employed physicians fell from 74% to 63%, while the rate for employed physicians fell from 73% to 55%. Employed female physicians are less likely to be satisfied with their work situation than their male peers. While both self-employed women and men have a 62% satisfaction rate, employed women have a somewhat lower rate (51%) than employed men (58%). Why the gender gap among employed physicians? "Many women physicians opted for employed status because they wanted a better work-life balance, and they may have been disappointed with the schedule they got," Greg Mertz says. Employed physicians who switched to self-employment are much more likely (71%) to say they're happy with the move than self-employed physicians who switched to employment (40%). What accounts for the gap in happiness? "You really have to be motivated to switch back to private practice, because it's very hard to do so," Greg Mertz says. So if these doctors manage to make the switch, they tend to feel very satisfied, he explains. On the other hand, physicians switching to employment may have overlooked unpleasant aspects of the job, Marc Mertz says. "They may not appreciate how much life will change for them," he says. These physicians "often feel that the hospital wasn't completely open with them about what employment would mean," he says. Only a little over half (57%) of employed physicians who switched from self-employment would recommend employment to others. Greg Mertz attributes this lukewarm response to the ease with which doctors can enter employment. With hospitals pushing them hard to sign up, "there will be many employed physicians who are not committed to this option," he says. Many employed physicians are conflicted about their work, according to Marc Mertz. "They usually like the financial security and not having to run their practice, but not their lack of clout in the organization," he says. Source
