Employee-Physicians Surge Past Independent Doctors

For the first time in U.S. history, doctors working as employees at large group practices outnumber solo practitioners.

The shift - the crossover point took place between 1992 and 1993 - is attributed in part to the growth of managed care, which makes it harder for solo practitioners and small group practices to negotiate contracts.

Now employee-physicians outnumber solo practitioners nearly 3-to-2, researchers said in today’s issue of The Journal of the American Medical Association.

“This is the first time we have reported shifts like this,” said Phillip R. Kletke, the study’s lead author. “That particular aspect of the change is occurring much faster than we anticipated.”

Experts disagree on whether the shift will tangle physicians in increased bureaucracy or free doctors to focus on taking care of patients.

Between 1983 and 1994, the share of doctors who were self-employed in solo practices fell from 40.5 percent to 29.3 percent, according to survey data provided to the AMA by U.S. physicians.

The proportion of doctors self-employed in group practices fell from 35.3 percent to 28.4 percent, while the share of physicians practicing as employees rose from 24.2 percent to 42.3 percent.

“If current trends persist, a majority of physicians will be employees in the very near future,” the AMA researchers said. However, these doctors will be subject to increasing bureaucratic oversight, less independence in making medical decisions, and intense pressure to watch bottom line, they warned.