Two sides to every coin: Assessing the effects of moving physicians to employment contracts

Abstract

There is a growing trend of physicians becoming employees of hospital systems and physician employment is viewed as a mechanism to increase hospital-physician alignment and improve quality and cost outcomes. Yet, the research is mixed on the effects of moving physicians to salaried employment and payment reform remains difficult to accomplish. While the literature has traditionally placed such forms of bureaucratic control in opposition to professional autonomy, it has often overlooked the effects on professional values at multiple levels and literature on payment reform has largely focused on financial or cost outcomes while overlooking relational effects. To address these gaps, we conducted a mixed method study at one hospital that recently moved all formerly self-employed physicians to employment contracts. We interviewed physicians to understand how payment reform effected their interactions with patients, their relation with and within the organization, and their expression of professional values. We then conducted a follow-up survey across both formerly salaried and self-employed physicians to further test our initial findings. We find both positive and negative effects at different levels, offering insights into the mixed results found in the current literature.