The association says this marks the first time that physician-practice owners fell below a majority share of the nation’s patient-care physicians since the AMA began tracking practice-arrangement trends.
The share of patient-care physicians with ownership stakes in a medical practice declined 6 percentage points over the last four years — from 53.2 percent in 2012 to 47.1 percent in 2016. In contrast, the share of patient-care physicians with employed positions (working for someone else) increased about 5 percentage points to 47.1 percent in 2016 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.
Younger physicians gravitating away from physician-practice ownership toward employed positions has had a big impact, the AMA says. The study found that 65.1 percent of physicians under age 40 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, the AMA study found.
Whether physicians are owners, employees, or independent contractors varied widely across medical specialties in 2016. The surgical sub-specialties had the highest share of practice 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), per the study.
While the majority of patient-care physicians (55.8 percent) still worked in medical practices that were wholly owned by physicians in 2016, this majority decreased from 60.1 percent in 2012. Most of this change occurred between 2012 and 2014. Physician movement toward hospital-owned practices and direct hospital employment appears to have slowed since 2014, the study found. The share of physicians who worked directly for a hospital, or in practices with at least some hospital ownership, was the same — 32.8 percent — in 2014 and 2016, the AMA says.
Despite challenges posed by a changing health-care landscape, most physicians (57.8 percent) provide care to patients in small practices of 10 or fewer physicians, per the study. However, it found 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.