In the last 10 years, physicians working in private practices have declined by nearly 15%, as have those who are self-employed, while doctors working in hospitals or practices partially owned by healthcare providers have soared.

According to the American Medical Association’s biennial analysis of physician practice arrangements, which is based on the nationally-representative Physician Practice Benchmark Survey, about 70% of doctors say that needing to negotiate better reimbursement rates with insurers, gain access to costly resources, and better manage payers' regulatory and administrative requirements drove them to sell their practices to hospitals and health systems.

Between 2012 and 2022, physicians in private practices dropped 13% from 60.1% to 46.7%, while those in hospitals as direct employees or contractors grew from 5.6% to 9.6%. Those in practices at least partially owned by a hospital or health system grew the most, from 23.4% to 31.3%.

“Practice viability requires fiscal stability, and the AMA’s Recovery Plan for America’s Physicians is explicit in calling for reform to our Medicare payment system that has failed to keep up with the costs of running a medical practice,” said AMA president Dr. Jesse Ehrenfeld in a statement.

Self-employed physicians also dropped by 9%, from 53.2% to 44%, in the same period, in contrast to those employed, who grew from 41.8% to 49.7%. This change was most noticeable among younger physicians under 45, with 31.7% of this age group self-employed in 2022, down 13% from 44.3% in 2012.

Employment within different practice sizes also changed, with small practices (10 doctors or less) becoming less frequent, dropping from 61.4% to 51.8%. Shares in large practices (50 or more) grew from 12.2% to 18.3%.

Shares in midsized practices, as well as those employed in private equity group-based practices and identifying as independent contractors, remained relatively unchanged.

AMA did not respond in time for publication.

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