Employed vs. independent practice: What physicians give up

Fifty-five percent of U.S. physicians now work for a hospital or health system, a nearly 50% jump since 2012. The economics of practice ownership have been picked over for a decade. What the arrangement feels like from the exam room has not. A team at RAND, a nonprofit research organization, set out to close that gap.

Writing in the July/August issue of Annals of Family Medicine, Sara G. McCleskey, Ph.D., and colleagues report on hour-long interviews with 30 primary care physicians conducted in spring 2024: 15 employed by health systems, 15 practicing independently. Everyone in the sample had been with their organization at least three years. Solo practices and private equity–owned practices were excluded.

The interviews covered autonomy, staffing, care coordination, workplace culture and how patients reach their physician. Five themes emerged, and the two models diverged on every one of them. What the researchers did not find was a winner. Each arrangement solved problems the other could not, and created problems the other did not have.

The authors are careful about what the work can carry. The sample is small and not nationally representative, recruited through a vendor panel that likely favors physicians willing to talk to researchers. The interviews capture what physicians perceive rather than outcomes anyone measured, and the authors flag social desirability bias themselves. They describe the findings as hypothesis-generating rather than definitive.

That is still worth a physician's time. The value here is not a verdict on which model performs better. It is a map of where each one predictably fails, which matters more than it sounds when the decision in front of you is whether to sign.