Less than half of patient care physicians have an ownership stake in their medical practice, according to a newly updated study on physician practice arrangements by the American Medical Association. That marks the first time that practice owners fell below a majority of the nation's physicians since the AMA began documenting practice arrangement trends.
The share of patient care physicians with ownership stakes in a medical practice declined 6 percentage points to 47.1 percent in 2016, up from 53.2 percent in 2012. In contrast, the share of physicians with employed positions increased about 5 percent to 47.1 percent in 2016, up from 41.8 percent in 2012.
As a result, there were equal shares of physician employees and physician practice owners in 2016, while 5.9 percent of patient care physicians were independent contractors.
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However, physician movement toward hospital-owned practices and direct hospital employment appears to have slowed since 2014. The share of physicians who worked directly for a hospital, or in practices with at least some hospital ownership, was the same in 2014 and 2016 -- 32.8 percent.
The preference of younger physicians for employed positions has had a prominent impact. Nearly two-thirds of physicians under age 40, 61.5 percent in total, were employees in 2016, compared to 51.3 percent in 2012. The share of employees among physicians age 40 and older also increased between 2012 and 2016, but at a more modest pace than younger physicians.
Whether physicians are owners, employees, or independent contractors varied widely across medical specialties in 2016. The surgical subspecialties had the highest share of owners (59.3 percent) followed by radiology (56.3 percent). Emergency medicine had the lowest share of owners (27.9 percent) and the highest share of independent contractors (24.8 percent). Pediatrics was the specialty with the highest share of employed physicians (58.3 percent).
While the majority of patient care physicians (55.8 percent) worked in medical practices that were wholly owned by physicians in 2016, this majority decreased from 60.1 percent in 2012. Although this share is more than 4 percentage points lower than that of 2012, most of this change occurred between 2012 and 2014.
Despite challenges posed by a changing healthcare landscape, most physicians, 57.8 percent, provide care to patients in small practices of 10 or fewer physicians. Yet there were signs of a gradual shift toward larger practices. In 2016, 13.8 percent of physicians were working in practices with 50 or more physicians compared to 12.2 percent in 2012.
A national survey released in November from analytics company Geneia found physicians who are employed by hospitals and corporations are more dissatisfied and burned out than those who work independently and in physician-owned practices.
The breakdown is revealing: 69 percent of corporate/hospital-owned physicians agree they are talking about work in a more negative way, compared to 51 percent agreement among physician/independent-owned respondents. That's a plus-18 percentage point gap in opinion between ownership models.