Article Review: “77% of U.S. Docs are Employees.”

In a recent article posted April 11, 2024 on HealthLeadersMedia.com, John Commins highlights a trend in the healthcare landscape: a staggering 77.6% of physicians in the United States are now employed by hospitals, health systems, or other corporate entities. This stat, provided by the Physicians Advocacy Institute (PAI), underscores a shift in the ownership and employment structure of medical practices over the past decade. 

According to data compiled by Avalere, the transition in medical practice ownership is striking. In 2012, only 25.8% of physicians were employed by hospitals or health systems. Fast forward to 2022, and that number jumps to 58.5%. What’s more interesting is that the ownership transition isn’t solely to traditional health care entities; non-physician entities like health insurers, private equity firms, and large pharmacy chains now hold a significant stake in physician practices. 

This shift in ownership is changing the way medicine is practiced in the United States. Physicians, who have the responsibility of providing the best possible care for the patients, now find themselves navigating a complex landscape where corporate interests and metrics intersect with clinical decisions. As PAI CEO Kelly Kenney puts it, “... it’s absolutely critical that physicians retain autonomy over medical decisions and the relationship with patients remain grounded in providing the best clinical guidance.”

Kenney’s words resonate with many of the healthcare providers that I work with. These healthcare providers are grappling with the pressures of maintaining their livelihoods while upholding their commitment to high quality patient care. I recently had the opportunity to speak with a primary care physician employed by a non-physician run business entity. They shed light on the challenges of their employment structure, particularly regarding compensation models tied to relative value units (RVUs). 

Under their contract, this physician receives a base salary until they reach a minimum RVU threshold. Any additional RVUs generated beyond this threshold results in a percentage bonus. On the surface, this appears to be a win win. They have a base salary and if they produce more RVUs, they earn more. However, when you look into the nitty gritty, one recognizes that there is a balance between meeting financial targets and delivering high quality care. 

The physician’s dilemma is compounded by the industry-wide norm of brief patient visits, typically lasting 10 to 15 minutes. While their employer doesn’t mandate these short appointments, the implicit pressure to maximize RVU generation is undeniable. This leaves the primary care provider grappling with a fundamental question: how can they reconcile the demands of corporate metrics with their ethical duty to provide comprehensive care? Ding Ding Ding Burnout

For this physician and many of their peers, there’s tension between two extremes. On one hand, there’s the temptation to prioritize financial incentives by churning through patient’s, sacrificing the depth of quality of interactions in the process. Everyone gets a prescription. Everyone gets a referral. Overutilization and unnecessary use of resources. 32-40 patients a day. On the other hand, there's the desire to prioritize patient well-being, even if it means falling short of productivity targets and inviting the constant scrutiny from Admin. Patients love you because you actually spend time with them and hear their concern. Patients do not feel rushed. You don’t get the bonus because you didn’t meet productivity goals. 

Finding this elusive middle ground requires a nuanced understanding of the intersection between medicine and business. It demands ongoing dialogue between employee, admin, and policymakers to develop sustainable models that prioritize both financial viability and patient outcomes. 

As it stands right now, many physicians feel as though they are a product and the admin is trying to squeeze as much productivity or value out of them as possible. It doesn’t matter if physicians are burning out or the quality of care is dropping as long as money is being made. Many of the physicians that I work with feel as though their employer is placing profits over patients. Many physicians understand that there needs to be a balance between finances and patient care. At what cost? For those that I work with, they’ve decided that cost will not be their mental health.

When you want to make a change in life, reach out. Start your journey with Chris Rabanera, take the first steps with a free 15-minute consultation. I provide online therapy in California, online therapy in Michigan, online therapy in Nebraska, online therapy in Utah, and online therapy in Las Vegas. As an experienced therapist, I specialize in physician burnout, grief counseling, anxiety, and depression. I also provide mental health treatment for men.