Environmental Scan: Economy and workforce
Employment
Private practice is becoming the less common structure of employment for physicians. According to American Medical Association data, physician ownership of practices dropped below 50% for the first time in 2016.5 The trend toward employed versus private practice physicians is expected to continue. The size of practices is growing, with about one-third of physicians working in a hospital-owned practice or employed directly by a hospital and around 40% in practices of 10 physicians or more.5 Of every 10 physician practices, 3 were hospital owned in 2016.6 Physicians are being called upon to do more data entry and administrative work; 21% of physicians’ time is now spent on nonclinical paperwork.7 The ripple-out effects of what amounts to a seismic shift in the work structure and work environment for physicians are only beginning to be studied in terms of overall personal satisfaction and impact on patient care.
Stephanie M. Levine, MD, FCCP, the designate president of the American College of Chest Physicians and professor of medicine in the division of pulmonary diseases and critical care medicine at the University of Texas, San Antonio, recognizes the significance of the move from private practice to employment and suggests that advantages could be offset by some potential negatives practicing chest physicians. She noted, “Pros include potentially more job security, more predictable work hours, perhaps a reduction in some of the traditional administrative ‘hassles’ with running a private practice, and possibly a better and healthier work/life balance. Some think that physician input and leadership in the employed model may have more influence on a health care system than in an individual private practice. Nonclinical work may be decreased, but it is not clear that this is true.
“The negatives include a loss of autonomy, a potential loss of personal ownership of our patients’ health, and the loss of a unique personal culture of private practice. Physicians may be subject to metrics imposed by the employer. In addition, we may see more job turnover since physicians could be less invested emotionally and financially; fewer patients seen since the structure is often salary based and not based on productivity; and increased shift work, set work hours, and schedules. Thus, the employer-based model may actually contribute to the ongoing physician shortage.”
Dr. Levine stressed the role of training programs to prepare physicians for what may lie ahead. “Training programs must prepare physicians for what to expect as employees.”
