Employed vs Self-employed Physicians: Who's Happier? These Are the Tradeoffs

Leigh Page


June 14, 2016

In This Article

Different Factors Vary in Importance

Is the grass really greener, or does it just appear that way? For many physicians, it depends which values are most important to you. Regular hours vs lack of autonomy? Productivity goals vs more night call?

Medscape examined the key issues affecting employed physicians, looked at the major differences in satisfaction between employed and self-employed physicians, and came up with some intriguing findings. Almost 5000 physicians answered questions about salary, productivity targets, work/life balance, and other important aspects of employment. The survey showed that although satisfaction for all physicians has been decreasing, it has fallen somewhat more for employed physicians than for the self-employed.

Some key findings:

Employed doctors are glad not to deal with running a practice, but dislike having less control over decisions. More than one half (54%) of employed doctors say that what they like most about their jobs is not having to deal with the business of running a practice. What they dislike most is the limited influence in the decision-making process (noted by 35%), and 24% are unsatisfied with their productivity targets.

Satisfaction for all doctors is falling, but more so for the employed. Overall, self-employed physicians are more satisfied than employed physicians (63% vs 55%). One of the reasons? "When the owner speaks, things happen." By contrast, many employed physicians say they feel they have no clout.

Straight salary is on the wane. The percentage of employed physicians who are paid a straight salary fell from 46% in 2014 to 38% in 2016, whereas those paid for productivity rose from 33% to 37%.

Employed doctors are lukewarm about productivity targets. As more employers switch to productivity targets for compensation, less than one half (44%) of employed doctors are satisfied with them, and just under one half (49%) are satisfied with their bonus structure.

Most employed doctors have good relations with leadership, but sometimes feel out of sync with their employers' goals. Less than one half of employed physicians (42%) said they disagreed with their employer regarding decisions about patient care, and more than one half (57%) disagree with their employers about workplace policy. But 44% said that employers are making greater efforts to get their feedback.

There's less switching between employed and self-employed status. The rates of doctors moving from self-employed to employed status (27%) and from employed to self-employed status (13%) were roughly one half the rates for each category in Medscape's 2014 survey: 52% and 29%, respectively.

Four in 10 employed physicians say they have a patient quota. Typically, the quotas they work under range from 21 to 25 patients a day, but some physicians must see more than 35 patients.

Female physicians are more likely to be employed than male physicians, but are less happy about it. Women make up 37% of employed physicians, which is higher than their 33% share of all physicians. But only about one half (51%) are satisfied with their work situation, compared with 58% of employed men.

Most physicians are unhappy with EHRs. A higher proportion (40%) of employed physicians are satisfied with their electronic health record (EHR) systems and tech support than are self-employed physicians (31%). One probable reason is that hospitals and larger groups are more likely to have tech support on staff, as well as other staff members who can help out if the physician is having EHR problems.


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