Employed Doctors: Love the Paycheck, Hate the Rules

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Doctors Who Switched: Are You Happier?

Often you can only know in retrospect whether you made the right decision. Are physicians who switched satisfied, or do they rue their career choice? About 70% of physicians who left employment in favor of self-employment reported that they are happier now. Only 9% who went to self-employment are unhappier now.

In contrast, less than half (49%) of formerly self-employed (now employed) physicians are happier now, and a quarter (25%) are unhappier now. Those results fit with the knowledge that many physicians had no choice in becoming employed.

How Are Employed Physicians Paid?

The most common salary arrangement for employed doctors is straight salary, which accounts for about 46% of respondents' employment arrangements. Increasingly, though, physicians have to meet productivity targets or a salary-plus-productivity formula. "Salary plus bonus is very common," says Bohannon.

"We expect payment trends to be RVU [relative value units] based as far as incentive bonus; we also just started tracking quality bonus, and I expect that that quality piece will grow."

A smaller percentage of physicians have a more complex compensation arrangement, which includes a bonus ladder above the salary and productivity targets. Some other payment methodologies include: base salary plus overtime after 40 hours per week; and compensation plus a percentage of collections.

Are Employed Doctors More Satisfied With Their Income?

Almost half of employed respondents (46%) said their satisfaction with their income increased when they went from being self-employed to being employed. For about another quarter (27%), satisfaction remained the same; and for just over a quarter (26%), satisfaction declined.

This doesn't necessarily mean that doctors earn more now that they are employed. Satisfaction could reflect higher income, more guaranteed income, or the fact that doctors work fewer hours for the same income they previously earned when self-employed.

"In primary care, employed primary care doctors do typically earn more than self-employed primary care doctors," says Bohannon. "It's due to lack of subsidization [by a large employer]. In every setting, usually the entity doing the employing is doing it not because they're going to make money on the primary care doctor's practice but because the practice is an entry point to the health system. The employers feel that it's okay if the left hand is losing money because the right hand makes it up, and so frequently they will pay a little more."

Is Patient Care Better in an Employed Setting?

More than half (53%) of employed physicians who were previously self-employed felt that patient care was superior in the employed setting, although more than a third (37%) felt that it was about the same.

Why would employment affect patient care? It's likely that some physicians may find that in hospitals or hospital-owned practices, the very rules that they find oppressive are also the ones that the hospital has established as mandatory safeguards. Hospitals typically have patient safety and quality committees, and there may be more safety measures in place than in some small or midsize practices. Hospital-owned practices may also focus more on potential liability.

Still, plenty of errors occur in hospitals, and 10% of respondents who had changed job situations said that patient care was worse in an employed setting.

As healthcare reform moves forward, employment is likely to continue to increase as doctors debate the pros and cons and determine whether employment or private practice is right for them. Private practice will still continue to attract many physicians, and doctors will examine their own goals and personalities to determine what is right for them.

Employed vs Self-employed Doctors: View Infographic


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