Project Description

Measuring Doctor Happiness. Are self-employed Doctors better off?

Medscape carried out a survey of just under 5000 physicians to see whether they feel they are happier as an employee or as a partner or independent practitioner.

On one side we have employed doctors, who recognise the many advantages of not needing to run a business while on the other independent physicians who are happy to run their own show and don’t need to adhere to policies they disagree with.

But many doctors in both groups still think that they’d be happier and better off in a different position. Some have chosen to make the shift and the survey asked them if they thought it was worth it.

Employed vs self-employed doctors

Interviewed population: 80% employed 20% self-employed.

Women provide up to 33% of the medical workforce, and a higher portion of them were employed when compared to men.

Higher female employment rates could be explained by the fact that many female doctors favour the “work-life balance” found in employment, where there are more predictable schedules and few to no call responsibilities which are preferred by the female population.

Younger physicians strongly prefer employment positions. Physicians younger than age 40 are twice as likely to be employed than self-employed (23% vs 11%).

However, the older physicians’ portion of the employment asset has been rising in time. This is because older doctors tend to use employment as a pre-retirement step.

Since private practices are no longer being sold for large sums of money, physicians prefer shutting them down and shifting to employment, where they can get better retirement benefits.

Shifting from self-employment to employment

Almost twice as many physicians have switched from self-employment to employment than the other way around.

The reasons why the shift to self-employed has less volume are quite simple. Firstly, it’s easy to shut down a practice and convert to an employee, while leaving an employment contract often implies moving to a different area to comply to anti-competitive contract clauses. Furthermore, starting a practice from scratch is a costly and tedious process.

In any case, this employed – self-employed back-and-forth movement has been decreasing in time.

This is also due to the fact that, physicians and hospitals are evaluating alternative collaboration models that don’t involve employment.

Where do employed doctors work?

The long-established tradition was for employed physicians to work in hospitals and large groups, while self-employed physicians worked in practices.

But things have changed, and nowadays nearly 20% of self-employed doctors work in a hospital, over 35% of employed physicians work in an office and up to 15% of all physicians work in alternative settings such as academic, research, military, home care.

However, lately there has been a modest trend of hospitals returning to a preference for the direct employment of physicians.

Reasons for choosing employment

The most important reason for choosing employment cited in the survey was financial security. This was followed by fewer administrative responsibilities.

This is surprising since employed physicians actually have many administrative duties, even if they don’t have to manage an office.

Over 10% of physicians passed to employment not for choice but because they were forced to sell their practice.

The favorite aspects of employment included:

  • not having to run a practice (with aspects such as billing, IT, hiring, regulations, disciplining staff, etc),

  • work-life balance

  • more regular hours.

What doctors like about employment

Among employed doctors, hospitalists seem to be the happiest in regards to work-life balance and having less or no calls is often one of the key attractions of employment.

Most healthcare organisations nowadays hire physicians in a variety of specialties who specifically do calls, therefore employed physicians have relatively few problems with calls. The majority of them only have a call once every 5-10 nights or even more infrequently.

What doctors don’t like about employment

In general, doctors seem to suffer from the plethora of rules and rigid hierarchies set out by today’s healthcare organisations which have been repeatedly reported as an obstacle to efficient patient care.

Employed physicians often have to work extra hours at the end of the day to document, close EHR records and orders, and fill out paperwork so as to comply to structures, policies, and procedures. Hospital doctors are also expected to join committees and attend many meetings, while this is less of a issue for employed physicians practicing in the community.

Therefore, employed physicians feel they have to work hard to meet salary-tied productivity goals, have less choice on work-load than in private practice, and often cite excessive rules and report a lack of control and autonomy as a major disadvantage in employment.

Other sources of unhappiness for employed doctors are inflexible work schedules and short deadlines for turning in medical records as organisations push towards standardisation.

Self-employed doctors are the happiest

Surprisingly, satisfaction with work is higher among self-employed physicians than employed physicians and the main reason for this seems to be the higher level of control (63% vs 55%).

However, satisfaction rates for both employed and self-employed doctors have plummeted in the last years.

Discontent has grown most among employed doctors and has apparently female physicians have been hit harder.

Physicians who switched from employment to self-employment are much more satisfied than those who transition in the opposite direction (71% vs 40%) and most of those who passed to employment wouldn’t recommend it to others.

The higher levels of satisfaction among self-employees is probably due to the fact that switching back to private practice is very hard and doctors who manage it tend to feel very gratified.

Employers in the US are also suffering from the shift to productivity-based salaries. Straight salary contracts will probably continue to decline as hospitals are becoming more and more attentive in regards to productivity.

Employed doctor pays

Just over half (54%) of interviewed physicians answered they were happy with their incomes, and this figure is a little higher than it was in 2014 (49%).

There is no relevant difference in the global satisfaction with income between employed and self-employed doctors.

Starting incomes for employed physicians tend to be higher, but self-employed doctors have the potential to earn more in time because of factors such as patient population selection and being able to charge for additional services.

However, there is a significant level of dissatisfaction among employed physicians with the new trend towards productivity-based salaries.

Relationship with leadership among employed doctors

Almost two thirds of employed physicians have a good relationship with their leadership.

With increasing reports of physician burnout, employers have recently become more concerned about and several of them are trying to increase physicians’ happiness in practice. Many are seeking to trim administrative burdens and recruit physicians into leadership roles so as to provide better support to employed physicians.

Most (61%) of the disagreements between physicians and their employer regard workplace policies, with most issues falling within the area of staff management.

A need for increased leadership involvment

Increasing rates of employed physicians are satisfied with their autonomy at work as on the one hand they seem to be coming to terms with the new terms of standardisation while on the other hand they are becoming more involved in creating them.

However, still just under half of employed physicians feel that they don’t have a collaborative relationships with management and only one third feels that they are treated more like a partner than an employee.

It is therefore clear that Hospitals must try hard to work with physicians and realise that for the organisation to work well, it needs to have physicians deeply involved in the revision of the care process and the reduction in care costs.”

Daily patient quota

In 60% of cases doctors say they don’t have a say on how many patients to see in a day. Typical quotas range from 21 to 25 patients each day, but some physicians must see more than 35 patients.

The implicit risk of incentive payments is that the physicians’ appointment schedules may force them to see a certain number of patients each day. Unfortunately the survey didn’t enquire physicians’ view on these quota.

Work-life balance in employment

Just over half (54%) of employed physicians considered their work-life balance improved after they left private practice, while around 20% said it had actually gotten worse.

When you considering that work-life balance is considered one of the major attractions for seeking employment, these figures are pretty disappointing and are probably associated to long working hours associated to excessive administrative work.

Employee view on institution’s financial interests

Almost two thirds of employed physicians say that their institutions put patient outcomes before financial interests, 22% were neutral on this point and about 14% think that financial interests come first.

Career Satisfaction

Younger physicians are said to be quite comfortable with the employment model in their career. And even older physicians who switched to employment late in their careers are unusually content, Marc Mertz says. While these older physicians may never be completely comfortable with employment, “they don’t get so hung up on it because they’re in their golden years,” he says.

Meanwhile, physicians who are left in private practice tend to be very committed to the model and are doing well with it, Marc Mertz says. “These physicians are in that model for a reason; they want to have more control over how their practice is structured and operates,” he say

Summing up

In conclusion, both employed and self-employed doctors seem to be satisfied with their careers but while both maintain high levels of career satisfaction, self-employed doctors seem to be generally happier.

Source: Medscape Annual Report – Which Doctors are Happier – Employed or self-employed?