The doc in the grey flannel suit

Easter is a season of resurrection and redemption. So, it's a good time to remind ourselves that physician entrepreneurs are taking a more active involvement in innovating our way our of our sick care mess, not dying as some seem to think. The problem is that pundits confuse private practitioners as the only breed of physician entrepreneurs, when, in fact there are many.

The fact is that , according to a 2013 AMA report notes that 53.2 percent of all physicians surveyed were self-employed, and 60 percent of physicians worked in practices wholly owned by physicians. However, physician employment is rising and BIG MEDICINE is getting bigger. Sick care workers are not alone working for big companies

Employed physicians now exceed those who own their practices. The percentage of physicians working in private practice dropped 5% in two years. This is the largest such decline the American Medical Association has seen since kicking off its national survey in 2012, and likely does not capture the full impact COVID-19 had on these physicians.

Around 2005, more Americans started working for larger companies (> 2500 employees) than smaller ones.

From July 2015 to July 2016, 5,000 physician practices were acquired by hospitals, according to an updated?study ?from the nonprofit Physicians Advocacy Institute and Avalere.

For the study, researchers examined data comprising physician and practice location information and hospital and health system ownership from July 2012 to July 2016.

Here are five findings from the study.

1. Hospitals employed 42 percent of physicians in July 2016, up from 1 in 4 physicians in July 2012.

2. From July 2012 to July 2016, the number of hospital-employed practices increased by 36,000 practices, reflecting a 100 percent incline.

3. As of July 2016, nearly a third (29 percent) of physician practices were hospital-owned.

4. Between July 2015 and July 2016, the number of physicians employed by hospitals increased by 14,000 nationwide. The percentage of employed physicians grew by almost 11 percent during the same time.

5. Physician employment and hospital ownership of practices climbed for the fourth consecutive year nationwide when including July 2015 to July 2016 data. PAI and Avalere found the percentage of hospital-employed physicians grew between 5 percent and 22 percent in every region of the U.S. from July 2015 to July 2016. The same is true for the percentage of hospital-owned practices, which increased between 8 percent and 47 percent.

The most recent report indicates that the trend is continuing. Private practice in under siege.

The largest employer of physicians in the United States is not HCA, the VA, or Kaiser Permanente — it's UnitedHealth Group's Optum.

With at least 60,000 employed or aligned?physicians ?across 2,000 locations in 2023, Optum has cemented itself at the forefront of the quickly changing healthcare delivery landscape. For comparison,?Bloomberg ?reported in 2021 that Ascension employs or is affiliated with 49,000 physicians, HCA has 47,000 and Kaiser has 24,000.

The days of the stalwart solo physician, hanging out a shingle and seeing patients as he or she sees fit, are rapidly drawing to a close. Consulting firm Avalere Health reports that almost 70% of physicians in the United States now work as employees of a hospital, health system, or private corporation. That’s a 12% increase over just two years ago, and is likely to accelerate after the COVID-19 pandemic.

The move helps explain the ongoing shake-up in the world of work, with more people looking for flexibility, anxious about covid exposure, upset about vaccine mandates or simply disenchanted with pre-pandemic office life. It is also aggravating labor shortages in some industries and adding pressure on companies to revamp their employment policies.

According to a recent report, the pandemic has unleashed a historic burst in entrepreneurship and self-employment. Hundreds of thousands of Americans are striking out on their own as consultants, retailers and small-business owners.

Expect more turnover among employed physicians, says Jackson Physician Search, a leading recruitment firm. And the turmoil in the field is at least partly due to the extra burden the COVID-19 pandemic has placed on clinicians, according to?new survey data.

Based on survey responses from 400?practicing physicians and 86 administrators of healthcare organizations, a Jackson report finds that 54% of employed doctors are ready to make major career decisions. Of those physicians, 50% said they're planning to switch employers; 21% are opting for early retirement, and 15% intend to quit medicine. The rest have other plans.

https://www.medscape.com/viewarticle/947311

The move helps explain the ongoing shake-up in the world of work, with more people looking for flexibility, anxious about covid exposure, upset about vaccine mandates or simply disenchanted with pre-pandemic office life. It is also aggravating labor shortages in some industries and adding pressure on companies to revamp their employment policies.

The number of unincorporated self-employed workers has risen by 500,000 since the start of the pandemic, Labor Department data show, to 9.44 million. That is the highest total since the financial-crisis year 2008, except for this summer. The total amounts to an increase of 6% in the self-employed, while the overall U.S. employment total remains nearly 3% lower than before the pandemic.

The number of unincorporated self-employed workers has risen by 500,000 since the start of the pandemic, Labor Department data show, to 9.44 million. That is the highest total since the financial-crisis year 2008, except for this summer. The total amounts to an increase of 6% in the self-employed, while the overall U.S. employment total remains nearly 3% lower than before the pandemic.

Entrepreneurship, in my opinion, is not about risk takers who assume full responsibility for their successes and failures. Instead, biomedical and health entrepreneurship is the pursuit of opportunity with scarce resources with the goal of creating user defined value through the discovery, design, development, testing, validation and deployment of biomedical products or health services or process innovation. It is definitely not practice management. Entrepreneurs manage risk, they don't just wildly take it.

Physician entrepreneurs can create patient defined value in many ways other than owning and running a private practice. They can be technopreneurs, social entrepreneurs, intrapreneurs, physician investors, or help other physician entrepreneurs get their ideas to patients providing services.

Physician entrepreneurship is not dying. Instead, to the contrary,we are witnessing the golden age of physician entrepreneurship. While a large number of doctors are seeking shelter in employed situations, my view is this is a temporary blip. New models of private practice and the intoxication of creating wealth through ownership will eventually drive a turnaround and we will see a bottoming out of employed physician numbers.

The irony is that while 10,000 medical school graduates can't get a residency slot, more and more doctors are pursuing non-clinical careers. More want in, more want out.

Getting a W-2 for the rest of your professional medical life is so 50's. A new generation of students in the pipeline who want to make a difference know it, despite some classmates who insist on working for The Man their entire career. The grey flannel suit or skirt just doesn't fit any more.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs? on Substack and Editor of Digital Health Entrepreneurship