Physician Employment Trends and Well-being

Family physicians consistently top the list of the most heavily recruited positions in the United States, according to Travis Singleton, senior vice president at physician search and consulting firm Merritt Hawkins. This means more opportunities and options, whether you’re considering offers for that first post-residency job or thinking about making a move from your current practice. And, Singleton says, this isn’t the only trend in physician employment that can make it easier to find a position that supports your well-being. 

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The Trend Toward Employment

About 90 percent of positions offered to new residency graduates are employed rather than independent. “We’ve seen the proliferation of delivery systems that offer employment ramp up even faster over the last year,” Singleton says.

This trend affects established physicians, too. Stakeholders—including insurers, delivery systems, and even physicians themselves—seem to be converging to consolidate physician practices. Currently, 68 percent of active AAFP members are employed (i.e., have no ownership stake in their practice), up from 62 percent in 2014.

What does the trend toward physician employment mean if you’re seeking a new position? It’s worth considering whether the security, stability, well-defined scope of practice, and controllable schedule offered by an employed position would support your individual sense of well-being. Employed physicians work with established systems, protocols, and processes, and other employees manage government payment systems and contracting.

In addition, because family physicians increasingly want greater harmony between their work life and their home life, employers are offering more options. For example, Merritt Hawkins sees physicians negotiating for a 20- or 30-hour workweek, flextime, extra paid time off, work location alternatives, or team structures with different physician-allied health professional ratios.  

Compensation Trends

Compensation is another factor that affects well-being. If you’ve decided that an employed position is the right fit for you, it’s important to be aware of key trends in physician compensation before you negotiate an employment agreement.

Salary

Starting salaries for both experienced physicians taking a new position and new residency graduates are increasing steadily. In family medicine, average starting salaries in all settings have gone up 30 percent since 2012--from $185,000 to $241,000. According to Singleton, one key factor driving this salary increase is a dearth of family physicians to meet the the growing demand for primary care at multiple sites of service. The prevalence of health-system–based practice ownership also contributes to higher salaries.

Family Medicine Starting Salaries

 LowAverageHigh
2017/18Low: $165,000Average: $241,000High: $400,000
2016/17Low: $110,000Average: $231,000High: $400,00
2015/16Low: $135,000Average: $225,000High: $340,000
2014/15Low: $112,000
Average: $198,000High: $330,000
2013/14Low: $140,000Average: $199,000High: $293,000
2012/13Low: $130,000Average: $185,000High: $437,000

Reprinted with permission from the Merritt Hawkins 2018 Review of Physician and Advanced Practitioner Recruiting Incentives. Base salary or guaranteed income only. Does not include production bonus or benefits.  

Incentives

According to Merritt Hawkins data, about 75 percent of physicians seeking employment are offered salary plus incentives based on performance. Government employers, urgent care centers, and federally qualified health centers (FQHCs) typically do not include incentives in employment offers.

Singleton notes that volume-based metrics (e.g., relative value units [RVUs]) are still the most prevalent driver of incentive calculations.  However, incentive models are evolving to support high-quality, cost-efficient care (e.g., value-based payment models) as more employers move toward contracts that weight quality and cost factors to determine compensation.

Negotiating Tips

When you’re negotiating an employment agreement, don’t hesitate to ask for expert help (e.g., from a health care transactional attorney). It’s also important to educate yourself on your options and know what to expect.

  • Know what is negotiable. Salary and non-compete clauses often are not, but incentives and other contract factors typically are. For example, you may be able to negotiate a schedule and team structure that fit your lifestyle.
  • Understand your contract term. Does it expire in two years so you’ll have another chance to negotiate, or does it renew automatically?
  • Understand how you would qualify for incentives and how they’re calculated. Is the goal work driven or resource driven? If it’s based on average RVUs, what is the source of that average? Does it get updated every year? If not, it will cost you.
  • Ask for data on how incentives have turned out for current employees. It’s a red flag if the employer won’t share this information, Singleton says. 
  • Find out how schedule changes will affect compensation. How will you be compensated for increased hours or expanded on-call duties?

Other Key Trends

Signing bonuses are offered in about 70 percent of Merritt Hawkins’ physician search assignments in family medicine and other specialties. For family physicians, these signing bonuses can range from $5,000 to $75,000, but the average is $25,000. Singleton says he is also seeing employers offer student-loan forgiveness benefits. To entice experienced physicians, some employers offer loan forgiveness for other types of debt, too.
 

Organizational Leadership Opportunities and Well-being

When it comes to well-being, one of the most encouraging trends Singleton sees in physician employment is the interest physicians—particularly younger physicians—are taking in leadership roles. If you’re considering an employed position, find out what leadership opportunities the employer makes available and express your interest in getting involved. For example, ask a potential employer about opportunities to have a seat at the table by serving on committees, volunteering for panels, or recruiting and engaging other physicians.

“We know that physician satisfaction is higher at physician-led organizations,” Singleton says. “So, it pays to understand who’s creating policies, deciding how to implement the electronic health record [EHR], and streamlining processes. If you can be part of that, it’s bound to have an effect on your job satisfaction and well-being.”



Written by AAFP editorial staff

Travis Singleton is an experienced health care staffing industry leader and national speaker serving as senior vice president at Merritt Hawkins in the Dallas-Fort Worth area. Merritt Hawkins is a physician and allied health search and consulting firm, a division of AMN Healthcare.
 

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