Half of physicians report they aren't their own boss

The majority of physicians in practice are working for someone else rather than owning a practice, in large part because solo practices are dwindling quickly, according to a survey by health care staffing firm Jackson Healthcare.

In a survey of 3,456 physicians released in June, 55% said they work for a hospital, a practice owned by a hospital or health system, or in an independent practice in which they have no ownership stake. Meanwhile, 37% owned their practices, and 8% worked as independent contractors or in locum tenens. In 2012, 47% of doctors worked for someone other than themselves, 44% owned their practices and 9% worked as independent contractors or in locum tenens.

The greatest gain in any category was doctors working as hospital employees, which went up to 26% in 2013 from 20% in 2012. Meanwhile, the greatest drop was also a six-point change: 15% of physicians in 2013 said they worked in solo practice, down from 21% in 2012. For the 2013 survey, 39% of physicians younger than 45 said they had never worked in a private practice, as an owner or employee.

Jackson Healthcare said the most common reason physicians reported choosing hospital employment over private practice was that they did not want “to deal with the administrative hassles of owning a practice.” Those doctors also said they wanted to be “a doctor and not a businessperson,” saw better opportunities for themselves in hospitals and didn't have the money to invest in a practice. Those who had left private practice for employment cited problems with high overhead costs, too many administrative hassles and payment cuts.

Jackson Healthcare said the physicians most likely to be satisfied with their work were hospital employees, while those most dissatisfied were practice owners. Overall, 58% of doctors said they were satisfied with their job, with 42% dissatisfied.

The company said it would not “propagate solutions” through its survey, but it didn't see the trends as positive for physician respect and autonomy.

“If we continue to devalue the experience and skills of our physicians, they will become the most expensive data entry clerks in the nation,” said Richard L. Jackson, CEO and chair of Jackson Healthcare.

Pressed by mandates

Jackson's comment about “data entry clerks” refers to one reason cited in many other surveys for doctors to seek employed situations, or leave practice altogether: the demand they invest in and adopt electronic health records. Under the federal meaningful use program, doctors can get Medicare and Medicaid bonuses for their use of technology but face cuts to Medicare pay if they don't.

Other surveys have cited uncertainty as the Affordable Care Act comes into full adoption in 2014, and the growing complexity of running a practice as reasons for physician unease. Although the physicians surveyed by Jackson Healthcare were self-selected rather than a random sample, the company's finding of only 37% of doctors owning their practices is consistent with other studies. For example, in late 2012, the health care consulting company Accenture analyzed American Medical Association and MGMA-ACMPE data to determine that 36% of doctors would be practice owners by the end of 2013, a number that has declined steadily since 2000, when the total was 57%.

A survey released earlier in 2013 by Jackson Healthcare found that the majority of U.S. hospitals were interested in acquiring physician practices, and that doctors were equally willing to work for hospitals. The most common reason hospitals gave for seeking acquisitions was that doctors came to them first.

Other results from June's Jackson Healthcare survey included:

• The percentage of doctors accepting Medicaid patients went up 3 percentage points in 2013, to 77%. Also, 70% reported accepting new Medicaid patients — a six-point gain.
• In the next five years, 18% of doctors plan to retire or leave medicine. In the next 10 years, 36% plan to do so.
• Interest in accountable care organizations is growing, with 25% saying they are in ACOs now, and 14% saying they plan to participate. In 2012, those totals were 22% and 9%, respectively.