Employed or Self-employed: Did You Make the Right Choice?

Leigh Page

Disclosures

October 12, 2016

In This Article

What Employed Doctors Don't Like

The biggest concern of employed physicians is lack of control. Asked in the Medscape survey to state what they liked least about employment, 35% cited limited influence in the organization's decision-making process, 28% cited less control over their work or schedule, 22% cited being "bossed around" by management, and 20% cited less autonomy.

Only 42% of hospital-employed physicians said they had the staff and support to do their jobs well, according to a 2016 survey[3] of employed physicians by Jackson Healthcare, a physician staffing firm.

Employed physicians often have limited control over staff, according to Dike Drummond, CEO of The Happy MD, a physician coaching service in Mount Vernon, Washington. "Your medical assistant and receptionists are hired and fired by a middle manager, sometimes without your input, consent, or awareness," he stated in an article[4] about the "top gripes" of employed physicians.

Dr Ramirez recalls that as an employed physician, he had no ability to make changes in staffing, and the organization controlled his schedule. "I really wanted the autonomy," he says. "I wanted to be the boss and not run decisions by anyone else."

Physicians coming out of private practice are used to having control over their practice managers, but the managers for employed physicians, called "site managers," work for the hospital. Often, they oversee several different physician offices.

Another kind of lack of control is feeling forced to make clinical decisions to keep costs down. In the Medscape survey, 37% of employed physicians said they frequently or occasionally feel pressured to make patient care decisions they disagree with.

This sort of intrusion may be indirect, such as requiring proof that a patient needs to be admitted. But usually, physicians are allowed to exercise their own patient care decisions, according to hospital consultants.

To protect against this intrusion, some physicians have been able to put a "professional autonomy" clause into their contracts, ensuring that they cannot be ordered to provide care or engage in practices they think are not medically or ethically appropriate, according to Merritt Hawkins.[5]

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