For more than a decade, the story of physician employment has been one of steady consolidation, with more physicians shifting to employment by hospitals, health systems and corporately owned practices.
But as employment increases, so has a sense of moral injury and a lack of practice autonomy, according to several recent physician satisfaction reports.
The Physicians Advocacy Institute, working with Healthsperien’s Center for Health Research, Policy and Strategy, surveyed 1,003 employed physicians this year and found a workforce that is, by most measures, deeply consolidated — and, by many of the same measures, increasingly strained.
Here are 15 numbers from that survey that outline where the pressure is building.
1. 82% More than eight in 10 practicing U.S. physicians are now employed by a hospital, health system or other corporate entity, up from 25% in 2012, according to the survey.
2. 64% Nearly two-thirds of physician practices nationwide are now corporately owned. For the first time, non-hospital corporations — private equity firms, insurers and other investors — own a larger share of those practices (33.2%) than hospitals do (30.6%).
3. 79% Physicians employed directly by insurers report the tightest restrictions of any employer type: 79% said they feel pressure to keep patients in network, and 77% said their employer imposes referral barriers. Hospital-employed physicians report less of both (58% and 63%, respectively), as do those employed by private equity or venture capital firms (59% and 57%).
4. 63% Across employer types, 63% of employed physicians said they’ve faced corporate barriers when trying to refer a patient out of network, and 59% said they feel pressure to keep patients within their own health system regardless of where the best care might be.
5. 47% Nearly half of employed physicians, 47%, said they frequently feel pushed to prioritize patient volume over what they consider optimal care.
6. 88% About 88% of employed physicians report some level of professional burnout.
7. 89% Even so, 89% of employed physicians said they’re personally satisfied with the quality of care they’re able to provide — a gap that suggests physicians trust their own clinical judgment even where they don’t trust the system built around them.
8. 73% About 73% said their patients have been unable to get timely appointments, and 45% said patients can’t get in within 48 hours for an acute problem several times a year or more.
9. 88% Separately, 88% of employed physicians encountered malfunctioning medical equipment that needed repair in the past year, and 43% said it happens monthly or more often.
10. 77% More than 77% of employed physicians reported care delays tied to prior authorization requirements, and 61% said prior authorization has caused a patient to abandon treatment altogether.
11. 44% About 44% of employed physicians are actively looking for a new job or seriously considering it. Inadequate compensation is the top reason, cited by 59% of that group.
12. 47% Nearly half of physicians, 47%, said they’d consider joining a trade union if given the option; just 25% said they definitely would not. Among those open to organizing, 85% want compensation and benefits addressed first, followed by contract negotiations (77%) and hours and scheduling (66%).
13. 14% About 14% of employed physicians said they plan to leave clinical practice altogether before retirement, and more than half of that group, 54%, cited professional dissatisfaction rather than retirement timing as the reason.
14. 35% Physicians who once ran their own independent practice are the likeliest to walk away. Loss of clinical autonomy was cited as a reason to leave by 35% of that group, compared with 21% of physicians who have never known anything but corporate employment. Twenty percent of former independent physicians said they plan to exit clinical practice entirely, compared with 12% of employed physicians overall.
15. 13% Just 13% of physicians under 40, about one in eight, have ever practiced independently at all — a sign that the pool of physicians who remember an alternative to corporate employment is shrinking with each graduating class.
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