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Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023
| Contributor Information
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Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Letting someone else handle business details and taking home a predictable paycheck can make working for corporate entities appealing to physicians. But what do they sacrifice for those benefits? This report explores how employed physicians feel about their jobs' perks and downsides, office cultures, respect from management, and other important aspects of work life.
In this report, gender is based on how physicians self-identified in our survey.
Some totals in this presentation do not equal 100% because of rounding.
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Employed doctors have been very clear with us about how little they enjoy business responsibilities and how much they like a steady income. In our 2014 report on employed physicians, these two job features also were in physicians' top three.
"That's fairly intuitive," says Tommy Bohannon, VP of strategy for AMN Healthcare's physician & leadership solutions division based in Dallas. "The two reasons that most physicians decide not to go into private practice are to avoid having to be a small business owner and to have a predictable income."
Bohannon doesn't think most doctors focus on whether managers do their jobs well or poorly. "They think they don't need to be managed. They want someone else to manage the payers and contracts, make sure the utilities are paid, and not a lot beyond that. They don't really see themselves as employees, and if you don't, does quality of management really matter?"
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Even though lack of autonomy was chosen less often (48% in last year's report), over time it has become a bigger factor with employed doctors (in our 2014 report, it was in the middle of the list at 27%).
Doctors as a profession are predisposed to expect considerable personal autonomy, says Robert Scroggins of ScrogginsGrear, a Cincinnati consulting firm that works with physicians. "On a daily basis, they're in a fairly autonomous position: Meeting with patients, coming up with a treatment plan, moving on to the next [patient]. So, when rules are dictated from above, they feel that autonomy is infringed upon."
Scroggins has noticed that irritation over a perceived lack of autonomy is often more pronounced among doctors who shifted from small practices into a more structured environment.
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
These numbers haven't changed much since last year's report. Once again, nearly 30% of employed physicians were looking ahead to retirement and about 1 in 8 would get out of medicine.
Some doctors who vow to follow a nonmedical career path then find it difficult to let go, according to Scroggins. "When the rubber meets the road, they find they're best equipped to be a doctor, and that's the profession that generates the best income."
Drilling into the data, 40% of doctors aged 45 or older tapped retirement as their next stop, and men of all ages were likelier than women to say so (32% vs 21%).
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
About the same share of employed doctors were satisfied or very satisfied with their compensation as in last year's report (56%). That is an interesting satisfaction rate, given that physicians rank among our nation's highest-paid professions, yet 71% of Americans in a recent Gallup survey said they were satisfied with their family income.
"The sense I get from my firm's own research and data is that it's not that physicians are so much upset with how much they're paid," Bohannon says. "It's that they're dissatisfied with their compensation structure. Many of them find bonus plans unclear and complicated, mixing emphasis on quantitative vs qualitative in a way that's hard to follow."
However, those feelings are not universal among employed physicians, he adds, with dissatisfaction over compensation running higher among younger doctors and in certain specialties.
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
In our surveys, employed physicians have been clear that autonomy and a respected voice in a medical organization matter to them. Here, about 9 of 10 doctors said it was somewhat or very important that their boss respected their contribution and opinion.
That belief didn't vary much if physicians were younger or older than 45, or if they worked in a medical office or a hospital.
Are doctors getting that respect for their contribution and input? "This is probably the biggest underlying frustration with employed physicians," Scroggins says. "They know what's best for their patients. Any [decision] that deviates from that to them feels like disrespect."
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Majorities of our respondents would rate their employers highly on several measures for the quality of the culture and staff interactions. Physicians working at medical offices generally were more positive about these features than were hospital employees.
"These findings are encouraging, great to see," Bohannon says. "What I have seen over 25 years in this business" is healthcare employers lagging other US industries in realizing the importance of workplace culture.
"This shows that they're focusing on creating a quality work environment, and I'm glad to see that it's working. Employee engagement is important."
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Employed physicians' outlook on this critical topic has been pretty stable in recent years. Fifty-four percent of them were satisfied or very satisfied with their work-life balance vs 51% in last year's report and 54% in our 2014 report.
How highly do doctors now value the ability to balance their professional and personal lives? In a 2022 study, staffing firm CHG Healthcare said work-life balance was the number-one factor for physicians who were choosing their first job.
Over time, employed physicians' satisfaction with their balance may tick down, Scroggins believes. "Doctors feel like there is so much for them to do now, with additional documentation and regulatory requirements for value-based care," he says.
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Over the past decade, the share of employed physicians who told us they were paid on a straight salary declined from 46%. The ranks of those compensated on a base salary plus productivity targets and other performance metrics rose from 13%.
Many doctors may not be thrilled with this shift. A 2019 survey of physicians, conducted by the Texas Medical Center Health Policy Institute, found that 68% would rather be compensated primarily or entirely with salary.
Don't be surprised if more medical employers draw the same conclusion over the next few years, Bohannon says. AMN's research points to more large medical groups dropping incentives for straight salary "because it causes less friction among the physicians … I don't know that anyone's figured out a great formula to reward both volume and value with production incentives."
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
It did not appear that physicians working at medical offices or hospitals got any relief from required paperwork.
Studies have shown that charting into an electronic health record system can add up to 1.5 hours to an average physician's regular workday, and overall, doctors spend an average of 15.5 hours per week on paperwork and administration.
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Only 25% of employed physicians told us that they work with a daily patient quota, virtually the same as the 24% in last year's report. Of those, half felt that their management gives them inadequate time to properly treat those patients.
Managed care insurers contractually limit the amount of time many US physicians can spend on average with a patient.
"I'm not surprised with a 50/50 split" on this question, Scroggins says. For the half of physicians who didn't feel that they have sufficient time, "as RVU requirements increase, the additional pressure to produce naturally leads to stress and frustration."
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
About the same share of employed physicians as in last year's report (77%) offered a positive, or at least neutral, outlook on the targets and metrics that their organization uses. Male doctors and physicians working in medical offices were likelier to call the targets and metrics fair than were their female counterparts and people working in hospitals.
"Agreeing to appropriate metrics when beginning your employment is important," Scroggins says. "However, when an employment contract renews, it is not uncommon for the productivity requirements to increase. A hospital might say you need to produce at a level like others in your specialty who work there or could start paying less for an RVU."
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Employed physicians' attitudes about their autonomy at work have remained pretty consistent over the past decade. When we asked this question a decade earlier, 49% of employed doctors expressed varying degrees of satisfaction and 25% showed dissatisfaction. In last year's report, 49% chose "very satisfied" or "satisfied," and 26% picked "very unsatisfied" or "unsatisfied."
"These aren't terrible numbers, but it's not great that only 50% feel autonomous," Bohannon says. "A lot of times when you ask a doctor an open-ended question about autonomy, their answer will be framed in … 'Someone who hasn't had my training shouldn't be telling me how to practice medicine.' There will be some friction there."
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Our surveys have verified that self-employed doctors face higher demands for on-call nights. And as in last year's report, less than a third of employed physicians were on call more than 5 nights in an average month.
Of note, employed doctors under age 45 increasingly avoided on-call nights altogether (30% of them reported zero nights in an average month, while 23% said the same last year).
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Employed physicians felt that the workplace rules are more sensible for the employer and patients than for themselves. Compared with last year's report (when 68% of respondents said the rules made sense for the business, 55% for physicians, and 71% for patients), they were slightly more skeptical that rules benefitted anyone.
In theory, Bohannon says, rules that are best for patients are also best for physicians, "since everyone is here for the patient." But many employed physicians are simply convinced that "they don't need heavy-handed management."
Doctors assigned to medical offices were more likely to voice support for the administrative rules than were hospitalists.
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Medicine Beats Managing: Medscape Employed Physicians Report 2023
Jon McKenna | August 22, 2023 | Contributor Information
Physicians report their successes and failures in building wealth, controlling spending, managing debt and expenses, investing smartly, and maintaining a comfortable lifestyle.Medscape Features Slideshows, Jun 2023
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Jon McKenna
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Medscape Business of Medicine
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