A new report looking at physician employment by hospitals and health systems offers six new principles for physicians to consider when evaluating employment opportunities. The principles were recommended in light of changes in the health care environment and recent studies of what drives physician satisfaction in practice.
The report also reaffirmed longstanding AMA policy that supports the freedom of physicians to choose their method of earning a living.
Created by the AMA Council on Medical Service, the report notes that there has been a shift toward hospital employment. The AMA’s 2014 Physician Benchmark Survey found that 26 percent of physicians worked in practices that were at least partially owned by a hospital, and another 7 percent were directly employed by hospitals.
In a more general look at physician employment across practice settings, the survey found that just over 50 percent of physicians were owners of their practices, while 43 percent were practice employees, and 6 percent were practice contractors.
The report also cites a 2013 study by the AMA and RAND on physicians’ professional satisfaction. The study found that doctors in physician-owned practices were more satisfied than physicians in other ownership models, such as hospitals and corporate environments. But work controls and opportunities to participate in strategic decisions were found to mediate the effect of practice ownership on overall professional satisfaction.
Building on such findings, the six principles in the report were adopted as AMA policy Monday at the 2015 AMA Interim Meeting. The policy advises physicians who seek employment as their mode of practice to strive for an arrangement that offers these characteristics:
- Physician clinical autonomy is preserved.
- Physicians are included and actively involved in integrated leadership opportunities.
- Physicians are encouraged and guaranteed the ability to organize under a formal self-governance and management structure.
- Physicians are encouraged and expected to work with others to deliver effective, efficient and appropriate care.
- A mechanism is provided for the open transparent sharing of clinical and business information by all parties to improve care.
- A clinical information system infrastructure exists that allows capture and reporting of key clinical quality and efficiency performance data for all participants and accountability across the system to those measures.
The report noted a lack of empirical data and published research on the long-term effects of physician employment and encouraged continued research on how integrated health care delivery models that employ physicians effect patients and the medical profession.
Resources to aid physicians in employment arrangements
Employed physicians and those considering employment also have a variety of resources from the AMA at their disposal. They include:
- The Annotated Model Physician-Hospital Employment Agreement
- The Annotated Model Physician Group-Practice Employment Agreement
- The AMA Principles for Physician Employment, which address some of the more complex issues related to employer-employee relationships
- The AMA and American Hospital Association’s Integrated Leadership for Hospitals and Health Systems: Principles for Success (log in)
- A new leadership development program will be offered next year by the AMA and the American Association for Physician Leadership
