For the first time, less than half of physicians are in private practice, survey finds

The number of employed physicians has been steadily increasing for years, but now, for the first time, employed physicians outnumber those in private practice, according to the American Medical Association’s (AMA) latest Physician Practice Benchmark survey.

Roughly 49% of physicians were working in a private practice setting in 2020, the survey found—down from 54% in 2018 and 60% in 2012.

For the 2020 edition of the survey, the AMA queried a nationally representative sample of 3,500 MDs and DOs who spend at least 20 hours per week on patient care, do not work for the federal government, and practice in one of the 50 states or Washington, DC.

About 50% of physicians were employed in 2020, up from 47% in 2018 and 42% in 2012. The percentage of physicians who have an ownership stake in their practice dropped from 53% in 2012 to 44% in 2020. In 2020, about 6% of physicians were independent contractors.

‘A longer-term shift’

“The changes between 2012 and 2020 reflect the continuation of a longer-term shift from physicians as practice owners to physicians as employees of practices or of other organizations,” wrote Carol K. Kane, PhD, in an AMA policy paper (PDF) on the survey results.

Contributors to this shift include a significant uptick in the number of practice mergers and acquisitions as well as more new physicians choosing to be employed, Dr. Kane noted.

Both women physicians and younger physicians are more likely to be employed, the survey found. Fifty-seven percent of female physicians were employed in 2020, while 47% of male physicians were employed. Seventy percent of physicians younger than 40 were employed in 2020, compared to 51% of those age 40-54 and 42% of those older than 55.

Over 90% of physicians worked in four practice settings in 2020, according to Dr. Kane’s paper:

• Single-specialty practices—43% of physicians
• Multi-specialty practices—26% of physicians
• Solo practice—14% of physicians
• Hospital employment—9% of physicians

Pandemic’s impact unclear

At this time, the impact of the pandemic on changes in practice trends remains unclear, Dr. Kane noted. The survey questioned some physicians to determine whether their practice’s change in ownership was due to the pandemic; few physicians said the pandemic directly caused an ownership change.

“However, spending on physician services at the end of 2020 remained 7% below its pre-pandemic level,” Dr. Kane wrote. “This leaves open the possibility that the impact of the pandemic on physician practice arrangements is ongoing and may not be fully realized until later in 2021.”

Related reading:

What physicians got paid in 2020

What the pandemic could mean for physician compensation