To sign on as an employee or to go it alone?

That’s a hard decision for many physicians. On one hand, there’s a steady paycheck and a chance to concentrate on patients rather than administration. On the other, there’s independence and the pride of owning your own business.

Medscape’s 2022 Employed Physicians Report surveyed more than 1350 US physicians employed by healthcare organizations, hospitals, large group practices, or other medical groups to find out what they love about their jobs and what they don’t.

When asked what they liked most about their jobs, the two most common answers by employed physicians were a steady income (50%) and not having to run a business (52%). “I am not a businessman. I am a doctor,” wrote one respondent. Another said, “I don’t want to have to worry about hiring, firing, finances, and buildings.”

Sterling Ransone, Jr, MD, is a family physician in rural Deltaville, Virginia, and president of the American Academy of Family Physicians. Though his father was in private practice and Ransone grew up expecting he would finish school and “put up a shingle,” he and his wife (who is a pediatrician) ultimately chose to go the employed route.

“Running a business is something that I really wasn’t trained to do in medical school and residency,” he said. “The prospect of opening our own business and taking out more loans in order to cover the opening of the business was daunting.”

Twenty-one percent of all respondents and 28% of part-time workers cited work-life balance as what they liked most. “The stability is essential for my family and in theory lets me be home more with my kids,” noted one respondent.

Roughly half (51%) of employed physicians reported that they were satisfied or very satisfied with their work-life balance. That’s a slight drop from 2014, when 54% were satisfied or very satisfied. The stakes here are high. The Medscape Physician Burnout and Depression Report 2022 found that burnout has a strong or severe impact on the lives of more than half of doctors and negatively affects their personal relationships.

Young physicians in particular value work-life balance, according to an American Medical Association survey, which found that 92% of doctors under age 35 considered that balance important. Among employed doctors, 69% worked 5 nights or fewer per month, and that’s a big advantage to being employed. “When I am gone from work, I can be fully present at home, no on-call duties,” enthused one respondent.

Downside of Employment

What’s not to like? Less autonomy, according to 48% of respondents (and 51% of those working part time). “Doctors like their autonomy and don’t like being told how to practice medicine,” said Tony Stajduhar, president of employment agency Jackson Physician Search in Atlanta. Or as one respondent put it, “Poor management makes dumb rules.”

Many employed physicians feel they don’t have a voice in how their healthcare organization is run. “Often, the physician comes out of the pre-hiring discussions . . . believing they will have significant management influence,” said Robert C. Scroggins of ScrogginsGrear, a Cincinnati consulting firm whose clients are physicians and dentists. “But it rarely unfolds that way.” When it doesn’t, he adds, “it can be particularly frustrating that others are making management decisions that…impede [physicians’] ability to deliver excellent patient care.”

Ransone is sympathetic to these concerns. If peers are looking for an employment opportunity, he advises making sure the system they join is a good fit. He suggests asking questions such as, “How much autonomy will I have?” and “How will I be able to affect change in the practice?”

“When I talk with other folks who are employed,” Ransone says, “I think I’ve got it really good, because I know my system listens to the changes that we suggest. Not all of them are quite as responsive to the needs of physicians.”

Thirty-four percent of employed physicians were troubled by workplace rules, and 33% were troubled by less income potential. One respondent pointed out that employed physicians make less than private attendings do. However, employed physicians are more comfortable with their compensation ― 56% said they were satisfied or very satisfied with their incomes, up from 49% in 2014.

This increased satisfaction may be due to changes in how pay is structured. In Medscape’s 2014 report, 46% drew a straight salary, and only 13% were paid a base salary plus extra for meeting productivity targets and other performance metrics. This year, 32% were paid salary plus productivity bonuses.

At least some were troubled by the entire business model of their employers. One doctor said, “It is a conveyor belt, not real medicine that is patient-care focused.” While employed doctors may have problems with their bosses, physicians seem to work well with their fellow employees, with 70% saying that they are able to collaborate effectively or very effectively with other physicians and staff.

The Perks of Job Security

As the economy regularly goes through its ups and downs, employees in various industries worry about losing their jobs.

Physicians seem largely exempt from this concern, with 84% saying they felt their jobs were secure. Despite the feelings of security, most of the doctors surveyed didn’t seem to be in for the long haul; 68% reported that they didn’t expect their relationship with the organization they work for to last another 10 years. (Virtually the same number, 69%, of self-employed doctors told Medscape that they feel similarly about their own careers.) This could reflect the aging of the US physician population, but it could also be the result of pervasive burnout.

Most physicians surveyed (65%) said they had no concerns about clauses in their contracts. This surprised Stajduhar. “Physicians have had a lot of years to let attorneys review several iterations of their work contracts, so the clauses have become mainstream. But I still see a lot of noncompete clauses in contracts that I’m surprised physicians don’t push back on more.”

For most doctors, it seems, the advantages of secure, steady employment seem to outweigh the disadvantages (and risks) of independence.

While a recent study found that nearly three quarters of physicians are employed by hospitals or corporations, a figure that has increased in recent years, diversity in how physicians ply their trade is important, says Ransone.

“I think that it will behoove us all from a societal standpoint to encourage policies that will support all types of practice,” he said.

Avery Hurt is a Birmingham, Alabama-based freelance science writer who writes often about the science and practice of medicine.

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