Physician Employment Patterns: Challenging Conventional Wisdom

Abstract

Physician employment arrangements continue to spark considerable debate. Much of the concern generating this debate arises from a perception that bureaucratic management structures may adversely affect the relationships between employee physicians and their patients. However, the various participants in the health care sector are likely to view physician-employees in different ways. Both self-employed and employee physicians may be concerned that employee status may infringe on a physician’s professional autonomy. Patients, especially those not adept at dealing with large organizations, may worry that their caregivers will be less responsive to their needs because they are employed by a larger organization. Alternatively, both physicians and patients may view the larger organization as an aid to providing high-quality care. Third-party payers, which have become increasingly concerned with rising health care costs, may look to a larger management structure as a way to contain health care cost inflation. This DataWatch reports: (1) trends in the proportion of physician employees; (2) trends for the solo practice of medicine; (3) 1988 data on who employs physicians; and (4) projections of the number of employee physicians in the year 2000. Our data show that physician employment arrangements may be changing but, if so, at a fairly slow rate. Our analyses do not permit us to draw conclusions about the desirability of different employment arrangements, either in general or in particular, for patients, physicians, or third parties. Data for this report come primarily from the American Medical Association’s Socioeconomic Monitoring System (SMS) surveys. Since its inception in 1982, SMS has consisted of periodic telephone surveys of