Current trends in physicians' practice arrangements. From owners to employees.

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.

PARTICIPANTS

Nonfederal, postresident patient care physicians who provided more than 47 000 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.