Who do Doctors Work for?

The structure of physician practice arrangements has changed dramatically in the last decade or so.  The American Medical Association, among other organizations, has tracked the nature of physician practices.  It recently released its current analysis.  (AMA Release)  For the first time, in 2016 less than half, 47.1%, of all doctors own the practice they work in.  This is a drop from around 53% in 2012.  Practice size has also increased, with 58% of doctors in practices of 10 or less physicians, compared to 61% in 2012.  Meanwhile, large practices with 50 or more doctors have gone from comprising 12% of doctors in 2012 to 14% in 2016.  About 33% of physicians are in hospital-owned practices or employed directly by hospitals, compared to 29% in 2012.  Younger doctors are significantly less likely to have an ownership stake in their practice.  Women physicians are also but this may be because they are younger on average and tend to be in specialities where employment is more common than practice ownership.   The ratio of doctors in solo practice or in a larger group practice tends to vary widely by specialty.

The reasons for the shift away from owned practices are pretty well understood–the reimbursement pressures, the costs of IT systems, and regulatory compliance costs play a major role.  It is less clear what the impacts are on physicians, but there are several surveys suggesting they are experiencing less job satisfaction and more burnout.  And financially, consolidation and hospital ownership drives up spending.