A new study on physician practice arrangements by the American Medical Association shows that most physicians provide care to patients in small practices. Even so, the percentage of doctors who work directly for a hospital or in practices that have at least some hospital ownership continues to increase. “These data show that the majority (60.7 percent) of physicians were in small practices of 10 or fewer physicians, and that practice size changed very little between 2012 and 2014 in the face of profound structural reforms to health care delivery,” AMA President-elect Andrew W. Gurman, MD, was quoted as saying. Using data from the AMA’s Physician Practice Benchmark Surveys, the most recent “Policy Research Perspective” report describes the practice arrangements of physicians in 2014 and the changes in practice that occurred between 2012 and 2014. Where possible, the current data are compared to that from 30 years ago to offer a long-term perspective.
Employee or owner?
While the majority of physicians (56.8 percent) worked in practices that were wholly owned by physicians in 2014, this majority decreased slightly from 60.1 percent in 2012. In contrast, the share of physicians who worked directly for a hospital, or in practices that had at least some hospital ownership, increased from 29 percent in 2012 to 32.8 percent in 2014.
Other changes in physician practice arrangements that occurred between 2012 and 2014 include:
- The share of physicians who were practice owners decreased from 53.2 percent to 50.8 percent.
- The share of physicians who were in solo practice decreased 18.4 percent to 17.1 percent.
- The share of physicians who were directly employed by a hospital increased from 5.6 percent to 7.2 percent.
- The share of physicians who were in practices that had at least some hospital ownership increased from 23.4 percent to 25.6 percent.
The 2014 owner percentage – 50.8 percentage – is well below what it was in 1983, when 76.1 percent of physicians owned their practices, according to the report.
Younger physicians were more likely to be employed by their practice than older physicians. In 2014, employment ranged from 59.0 percent among physicians under the age of 40 down to 33.3 percent among physicians over the age of 54. In particular, younger physicians were more than twice as likely as older physicians to be employed by hospitals. Twelve percent of the under-40 cohort were direct hospital employees compared to only 4.8 percent of physicians over the age of 54. Still, 34.1 percent of physicians under the age of 40 were owners.
Gender gap
In addition to age differences in physician employment, gender differences are present as well, reports AMA. In 2014, 51.8 percent of women physicians were employed by their practice compared to only 38.8 percent of men. Several factors that contribute to the gender gap.
- Because women have entered medicine more recently than men – during a time when employment increasingly has become the norm – women are more likely than men to be employed. In 2013, 24 percent of women physicians were under the age of 35 compared to only 13 percent of men.
- Gender differences in specialty choice are also a contributing factor to the gender gap in ownership status. Women tend to practice in specialties that are “employee heavy.” For example, in 2013, 17 percent of women physicians were pediatricians compared to only 6 percent of men. Pediatrics has historically been a specialty that has a higher than average employee share. In 2012, 59.4 percent of pediatricians were employees compared to the specialty-wide average of 41.8 percent. Even in 1987, when many fewer women practiced medicine, 37.2 percent of pediatricians were employees compared to the specialty-wide average of 22.6 percent.
- To the same point, women physicians are less likely than men to choose certain specialties that are “owner heavy.” Seventy-two percent of surgical specialists were owners in 2012, the highest owner share across 12 broad specialty categories. Only 12 percent of women physicians were surgical subspecialists compared to 17 percent of men. JHC