Employed vs Self-employed Physicians: Who's Happier? These Are the Tradeoffs

Leigh Page

Disclosures

June 14, 2016

In This Article

More Administrative Duties and Patient Quotas

Only 15% of employed physicians cited fewer administrative responsibilities as a reason for taking their jobs; that was about one half the rate in the 2014 survey (29%).

Although they don't have to administer a practice, employed physicians actually have a lot of administrative duties, Marc Mertz says. "They still have deal with referrals, quality reporting, and EHR entry," he says. "And there's more data reporting going on in a healthcare system than in private practices."

A small percentage of employed physicians (13%) said it wasn't their choice to be employed. Greg Mertz says this could happen in two ways. They could have been forced to sell their practices because they were losing money, or they could have been outvoted by fellow shareholders in the practice who wanted to sell.

They might initially be unhappy with employment, but "they will get used to it," Greg Mertz says. "They will adapt to the situation. They really don't have a choice in the matter."

Meanwhile, 4 in 10 employed physicians say they have a quota on how many patients to see in a day. Typically, quotas range from 21 to 25 patients a day, but some physicians must see more than 35 patients.

Marc Mertz adds that the level of required RVUs can define the number of patients physicians must see. "Physicians can take the RVU and calculate how many patients they have to see to meet it," he explains.

The number of patients a doctor can see varies widely by specialty and patient acuity.

Big Dissatisfaction With Their EHRs

Medscape's survey found that although the vast majority of physicians use an EHR, less than one half (40% of employed physicians and 31% of self-employed physicians) were dissatisfied not only with the EHR, but with the tech support they received for using it.

Marc Mertz says that when he presents to physician audiences, "I ask whether any of them like their EHR systems, and I don't see any hands going up," he says. He says EHRs present continuing problems for physicians. "Often these systems must be modified after implementation, causing inefficiency, waste, and frustration," he says. 

"Ideally, an EHR system should be a tool that supports the way a practice operates," he says. "Documentation at the point of care is best practice, but physicians find that the current systems are clunky and interfere with patient care and interaction."

Conclusion

For physicians, employment has clearly become much more common. For some physicians, it was their clear choice. Others say their practice was bought out, or they wanted to remain independent but their partners outvoted them and voted to sell to a hospital.

Although the steady hours; good income; not having to run a practice; and, in many cases, no call are still great lures for physicians, the lot of employed doctors has become tougher, with more rules and productivity targets. On the other hand, employed physicians are still happy about their careers and about the quality of care they provide. And hospitals and health systems seem to be more interested in listening to them.

There may be fewer physicians in private practice, but the ones who prefer it seem to be more satisfied with their work than are employed physicians. For them, the autonomy and being in charge of their own practice outweighs most of the negatives.

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