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From Owners to Employees

Phillip R. Kletke, PhD; David W. Emmons, PhD; Kurt D. Gillis, PhD

JAMA. 1996;276(7):555-560.

Abstract
Objective.
—To examine current trends in practice organization among postresident patient care physicians in the United States.

Design and Setting.
—The American Medical Association's Socioeconomic Monitoring System (SMS), a series of periodic surveys of nationally representative samples of nonfederal postresident patient care physicians. Physicians were divided into 3 categories based on the organization of their main practice. They were classified as employee physicians if they had no ownership interest in their practice, as self-employed solo physicians if they were in 1-physician practices in which they had an ownership interest, and as self-employed group physicians if they were in multiple-physician practices in which they had an ownership interest.

Particpants.
—Nonfederal, postresident patient care physicians who provided more than 47000 responses to SMS surveys between 1983 and 1994.

Main Outcome Measure.
—The proportion of nonfederal postresident patient care physicians who were employees between 1983 and 1994.

Results.
—Between 1983 and 1994, the proportion of patient care physicians practicing as employees rose from 24.2% to 42.3% (P<.001), the proportion self-employed in solo practices fell from 40.5% to 29.3% (P<.001), and the proportion self-employed in group practices fell from 35.3% to 28.4% (P<.001). Most of these changes occurred in the latter half of the 12-year period. These trends, which are evident in virtually every segment of the patient care physician population, are especially prominent among young physicians. The growing proportion of employee physicians is associated with increases in the earnings of employee physicians relative to those of self-employed solo physicians.

Conclusions.
—Current trends in the US health care system are rapidly changing the career opportunities of patient care physicians and, hence, physicians' choice of practice arrangement.

Author Affiliations
From the Policy Development Unit (Dr Kletke) and the Center for Health Policy Research (Drs Emmons and Gillis), American Medical Association, Chicago, Ill.

Footnotes
An earlier version of this article was presented at the 1994 annual meeting of the Association for Health Services Research, San Diego, Calif, June 13, 1994.

The views expressed in this article are those of the authors and do not necessarily represent the official position of the American Medical Association.

Reprints: Phillip R. Kletke, PhD, American Medical Association, Policy Development Unit, 515 N State St, Chicago, IL 60610.

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