Employment and Contract Considerations for Family Physicians in the Era of COVID-19


Family physicians may encounter unfamiliar employment challenges in the short-term, but long-term job prospects remain promising.

Fam Pract Manag. 2021 Jan-Feb;28(1):11-16.

Author disclosures: no relevant financial affiliations disclosed.

The coronavirus pandemic has had a profound effect on many aspects of health care, including the employment market for physicians. This article will explore how employment conditions for family physicians have changed as a result of COVID-19. It also will review current starting salaries, signing bonuses, and other features of physician employment contracts based largely on data from physician search firm Merritt Hawkins, with which we are affiliated.


Prior to the pandemic, the employment market for family physicians and many other types of physicians had been robust. The challenge was not finding a job, but selecting the right one from among a plethora of choices. For example, in 2019, the majority (69%) of primary care residents in their last year of training received 51 or more recruiting offers, and almost half (46%) received more than 100 offers.1

Beginning in March 2020, the job market changed as the pandemic brought financial duress to physician practices, hospitals, and other entities that recruit and employ doctors.

By August 2020, 72% of physicians reported a reduction in income as a result of the pandemic.2 Of those, 55% experienced an income reduction of 26% or more.2 Additionally, 8% of physicians reported closing their practices as a result of COVID-19, a number that unfortunately is likely to grow as the pandemic continues. It is probable that many of the independent practices that cannot weather the COVID-19 storm alone will look to merge with hospitals or larger medical groups to survive. In addition, fewer physicians may be inclined to open private practices in this environment. That means a growing number of physicians will be looking to hospitals or hospital-owned medical groups for employment.

However, hospitals also have taken a financial hit. The American Hospital Association estimates that U.S. hospitals lost more than $323 billion from March through December 2020.3

As a result, the pace of physician hiring has slowed significantly. Many practices and hospitals have neither the patient volume nor the financial resources required to recruit additional physicians. Instead, some physicians have been furloughed and others laid off, something we have never observed in our 33 years of recruiting.

Today, rather than having many practice opportunities to choose from, residents and practicing physicians may have to compete to secure positions that meet their needs. In addition, when comparing opportunities, physicians may find greater differences in scope of practice, compensation, sites of care, and other factors than they would have found pre-pandemic. Physicians will need to weigh these differences against their immediate and


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Travis Singleton is a former executive vice president of Merritt Hawkins/AMN Leadership Solutions, a physician search firm....

Phillip Miller is vice president of communications for Merritt Hawkins, a company of AMN Healthcare.

Author disclosures: no relevant financial affiliations disclosed.


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1. 2019 Survey of Final-Year Medical Residents. Merritt Hawkins; 2019....

2. The Physician's Foundation. A Survey of America's Physicians: COVID-19 Edition. Merritt Hawkins; 2020.

3. American Hospital Association. Hospitals and health systems continue to face unprecedented financial pressures due to COVID-19. June 2020. Accessed Nov. 14, 2020. https://www.aha.org/system/files/media/file/2020/06/aha-covid19-financial-impact-report.pdf

4. 2020 Review of Physician and Advanced Practitioner Recruiting Incentives and the Impact of COVID-19. Merritt Hawkins; 2020.

5. Frost A, Hargraves J. HCCI brief: trends in primary care visits. Health Care Cost Institute. October 2018. Accessed Nov. 14, 2020. https://healthcostinstitute.org/hcci-research/trends-in-primary-care-visits

6. The complexities of physician supply and demand: projections from 2018 to 2033. Association of American Medical Colleges. July 2020. Accessed Nov. 15, 2020. https://www.aamc.org/data-reports/workforce/data/complexities-physician-supply-and-demand-projections-2018-2033

7. Medical student education: debt, costs, and loan repayment fact card for 2019. Association of American Medical Colleges. October 2020. Accessed Nov. 15, 2020. https://store.aamc.org/medical-student-education-debt-costs-and-loan-repayment-fact-card-2019-pdf.html


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