Should I go independent?

If you’ve asked yourself this question, you’re not alone. Every year thousands of physicians across the nation switch from employment to self-employment or vice-versa, and unless you have a crystal ball sitting around, it’s not a decision that can be made overnight. For that reason, we’ve gathered some of the most relevant facts, stats and experiences from your colleagues around the country, so you can better weigh the pros and cons of running your own business.

Why independent doctors switch

Over the past several years, there’s been a steady increase of physicians choosing employment over independence. They’re joining either hospital systems or giant physician-staffing companies, such as TeamHealth of Knoxville, TN, and AmSurg’s Sheridan subsidiary.

According to member surveys by the Medical Group Management Association, the share of physicians who worked directly for a hospital or in practices at least partially owned by a hospital rose from 29% in 2012 to 33% in 2014.

Meanwhile, in a recent survey of 5,000 employed doctors conducted by Medscape, over half (54%) of respondents hired and/or bought out by a hospital, stated that the ability to turn over business matters was their primary reason to join the health system. Additionally, 41% looked forward to leaving behind their days of billing, insurance claims and reimbursements. Even such things as hiring, firing and disciplining of staff are thrown in the deal, which saves doctors many awkward conversations.

Guaranteed income was seen as favorable among those surveyed (41%), followed by a good benefits package (26%), malpractice coverage (22%) and more regular hours (20%). All in all, most respondents would much rather focus on their passion (patients) and leave business to someone else.

Other perks include a steady influx of patients, IT, infrastructure, equipment and last but not least, brand recognition: Large hospitals are local heroes when it comes to sponsoring events and local celebrities when it comes to advertising. One could say that employed doctors become cool by association. Not bad, right?

Why employed doctors switch

To the untrained eye, being part of a health system seems like a no-brainer, based on Medscape’s survey: More time caring for patients and less time sitting in front of a computer, all while enjoying steady finances. However, after a closer look Medscape discovered that 35% of employed doctors disapproved of their limited influence in decision-making (e.g. managing cost of care) and 34% felt that having a steady income also meant limiting their income potential. They also complained about dealing with too many rules in general (26%), being “bossed around” by management (22%) and less/lack of autonomy to practice medicine their way (20%).

Greg Mertz, Managing Director of Physician Strategy Group, a performance-improvement consultancy for physicians in hospital-affiliated and private settings, stated that even though employed physicians enjoy regular hours, they still have to work hard to meet the productivity goals often tied to their salaries. “An employed physician often doesn’t have the option of working less like one does in private practice,” he says.

Furthermore, hospitals tend to impose high patient volumes on their physicians, pressuring them to keep one eye on their patient and one eye on the clock. Some of them say they’ve been asked to see people every 11 minutes, putting patient satisfaction on the line.

Others have also gone independent after wondering about:

  • How long do I have to wait until I can get new equipment or supplies for the office?
  • How do I handle an employee causing problems who works for the hospital, not myself?
  • How do I get additional benefits like nursing home insurance for my family and I?
  • How good is my job security with the hospital?
  • How do I deal with hospital policies causing problems with patient care?

Remember, hospitals are companies and companies have policies, and usually the bigger the company, the more policies there’ll be. Not 100% doctors will agree with 100% of the policies.

For employed physicians, these policies mean signing away their right to make any important decisions that might impact their professional life or financial health, as well as which direction the practice should take. It can be both a blessing and a curse, depending on the physician’s expectations and the hospital’s policies.

As far as patients are concerned, independent doctors have a higher incentive to hold care and consideration to higher standards, since their financial success is directly and strictly tied to patient satisfaction and word of mouth.

Making a decision

Staying on payroll or running your own doesn’t come without compromise, so it all boils down to your expectations as a professional:

  • Are you planning on selling your practice after building trust in the community?
  • Do you appreciate the liberty of flipping the open sign at your discretion?
  • Do you appreciate a steady income and lower risk?
  • Do you trust your ability to run a business?

Once you’ve asked yourself these questions, tell us: What are the challenges you’ve faced in your current position? What are you looking to achieve if you’re considering a switch?



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AAFP Insurance Services
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