Physician employment by hospitals, health systems and other corporate entities has become a default in medicine as independent practice dwindles across most specialties
Hospital, health system and corporate ownership of physician practices climbed from 39% to 59% between 2019 and 2023, and physician employment by those entities rose from 62% to 78%, according to a Progressive Policy Institute report released in December. A separate analysis from the Physicians Advocacy Institute and Avalere Health found 77% of physicians employed by hospitals or corporations as of January 2024.
For physicians who have opted for employed models, the trade off has traditionally been an exchange of operational and clinical autonomy for job security and administrative relief. That bargain is now being tested by what’s happening to compensation, workload and turnover inside the organizations that absorbed all those practices.
Marcelo Hochman, a Charleston, S.C.-based independent physician and former president of the Independent Doctors of South Carolina, told Becker’s earlier this year that the security consolidation promises rarely survives contact with what employment looks like day to day.
“The allegiance of the employer to the employee is much weaker than the other way around,” Dr. Hochman said. “It’s just not under your control.”
Consolidation is pitched as a path to more coordinated, affordable care. Dr. Hochman said the reality often looks different.
“You become a very small cog in a gigantic wheel,” Dr. Hochman said, describing the trade of autonomy for a paycheck.
This becomes clear in a more detailed analysis of health system layoff trends. The five largest health system layoffs this year concentrated in corporate and administrative roles, not physician positions. The result for physicians has been subtler than job loss: more work with less support. Physician productivity rose 8% year over year in the fourth quarter of 2024, according to Kaufman Hall, even as median support staff per 10,000 work relative value units fell from 3.28 to 3.01.
Turnover has climbed too. The annual physician turnover rate rose 43% between 2010 and 2018, according to a study published in Annals of Internal Medicine, and a 2026 SullivanCotter and Lotis Blue survey found clinical autonomy — not pay — is now the strongest predictor of whether a physician stays, driving 22% of retention decisions.
Physicians employed by private equity-owned practices reported 44.8% professional satisfaction, versus 74.4% for non-private-equity peers, according to a March 2024 JAMA Internal Medicine study. Bain & Co. found a similar split, with 70% to 90% satisfaction in physician-led organizations versus 50% to 75% in health system-led ones. A 2024 Physicians Foundation survey found nearly 25% of health system-employed physicians were considering a switch, versus 14% of those in physician-led practices — and 37% of would-be movers wanted physician-owned settings.
All of these findings compound an existing shortage, with the Health Resources and Services Administration projecting a shortfall of 141,160 full-time equivalent physicians by 2038, and burnout.Compensation is also losing ground as the reason physicians pick an employer; culture and autonomy increasingly outweigh pay.
Dr. Hochman ties that burnout directly to lost control.
“Burnout happens when you lose autonomy,” Dr. Hochman said. “It’s what people call moral injury: being forced to practice in a way that goes against what you would do if you had total control.”
Dr. Hochman has pushed for policy fixes over individual workarounds, pointing to South Carolina’s 2023 repeal of its certificate-of-need law as proof physician advocacy can move policy. A bill to repeal physician noncompetes is now moving through the state legislature.
“Patients want to see their doctor, and patients need to start asking for alternatives,” Dr. Hochman said. “Patients need to actually ask for what they want and know that alternatives are out there.”
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