Self-employed physicians appreciate the autonomy; employed physicians favor the steady salary. What's the right decision for you?
Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit.Alexandra Kharazi, MD, a California-based cardiothoracic surgeon, previously worked as an employed physician and is now in private practice. Though she appreciates that there are some trade-offs to working with her small group of three surgeons, Kharazi has no qualms about her choice.
By hanging up her own shingle, Kharazi may be living a rapidly shrinking dream. According to the American Medical Association , between 2012 and 2022, the share of physicians working in private practice fell from 60% to 47%. The share of physicians working in hospitals as direct employees or contractors increased from about 6% to about 10% during the same time period.
When asked what they like most about their jobs, employed physician respondents reported"not having to run a business" as their number-one benefit, followed closely by a stable income. The fact that employers pay for malpractice insurance ranked third, followed by work-life balance. Other complaints included the requirement to reach high productivity targets and too low an income potential. In the 9 years since Medscape's 2104 Employed Physicians Report, the share of employed doctors paid on a straight salary has declined from 46% to 31%. Those compensated on a base salary plus productivity targets and other performance metrics rose from 13% in 2014 to 32% now.
Along those lines, younger generations in general tend to place work-life balance as a higher priority than do older generations, and employed physicians place this equation high on the list as well. In the Employed Physicians Report 2023, 54% said that they are satisfied or better with their work-life balance, up from 51% in the 2022 report.
Hospitals try to incentivize doctors with perks like hefty sign-on bonuses, student loan forgiveness, plenty of vacation time, and more. They also put money into marketing their doctors, a time-consuming and expensive aspect that is tough to shoulder in private practice, especially in the early years. Futch adds that many doctors view employment as a more stable option."As the government changes reimbursement policies, the income from private practice fluctuates," he said.
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