Abstract
Over the last 15 years, the health care practitioner landscape has changed significantly. Fewer practitioners are self-employed and more are employed by for-profit or nonprofit organizations. These shifts can have an impact on annual labor earnings. To examine trends in self-employment and employment and to assess the gap in annual labor earnings between self-employed and employed US health care professionals from 2001 to 2015. Survey study in which data on employment type (self-employed, employed by private sector, or employed by government) and annual labor earnings for 50 states and the District of Columbia were extracted from the 2001 to 2015 American Community Survey. The analyses were restricted to 175 714 self-identified dentists, physicians, pharmacists, optometrists, podiatrists, chiropractors, and physical therapists aged 30 years and older who worked at least 40 weeks per year and 20 hours per week. Controlling for age, sex, race/ethnicity, year, and state of residence, median regression models were used to measure the gap in annual labor earnings between self-employed and employed health care professionals. Annual labor earnings, defined as the sum of self-employment and wages or salary income. Our sample of 175 714 respondents included 99 077 physicians, 20 008 dentists, 26 143 pharmacists, 4238 optometrists, 6076 chiropractors, 1164 podiatrists, and 19 008 physical therapists. The weighted percentage of self-employed physicians decreased from 35.2% (95% CI, 34.4%-36.1%; 6807 of 18 726 physicians) in 2001 through 2005 to 24.7% (95% CI, 24.2%-25.2%; 10 974 of 41 205 physicians) in 2011 through 2015. The percentage of self-employed dentists decreased from 73.0% (95% CI, 71.2%-74.8%; 3117 of 4153 dentists) in 2001 through 2005 to 65.1% (95% CI, 63.7%-66.4%; 5260 of 7820 dentists) in 2011 through 2015. Among physicians, the regression-adjusted earnings gap reversed from $19 679 (95% CI, $14 431-$24 927; P < .001) during 2001 through 2005 to -$10 623 (95% CI, -$14 547 to -$6699; P < .001) during 2011 through 2015. Among dentists, the regression-adjusted earnings gap narrowed from $30 448 (95% CI, $23 040-$37 855; P < .001) during 2001 through 2005 to $21 291 (95% CI, $15 723-$26 859; P < .001) during 2011 through 2015. From 2001 to 2015 the earnings gap also reversed among pharmacists, optometrists, and podiatrists. The regression-adjusted earnings gap narrowed among chiropractors and physical therapists. Since 2001, the percentage of health care professionals who are self-employed declined, and the gap in earnings between self-employed and employed health care professionals narrowed.
Highlights
In health care, there has been a shift away from self-employment.[1]
From 2001 to 2015 the earnings gap reversed among pharmacists, optometrists, and podiatrists
The regression-adjusted earnings gap narrowed among chiropractors and physical therapists
Summary
There has been a shift away from self-employment.[1] Little is known about the gap in earnings between self-employed health care professionals and those employed by for-profit or nonprofit organizations (referred to in this article as employed). We analyzed this gap for dentists, physicians, pharmacists, optometrists, podiatrists, chiropractors, and physical therapists. These professions have a mix of self-employment and employment. We did not examine nurses or physician assistants because they are predominantly employed by physician practices or hospitals.[2]
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