Autonomy is top of mind for many doctors as healthcare becomes more centralized and the trend of doctors becoming employees continues to rise.

Nearly 108,700 doctors moved from private practice to salaried positions between 2019 and 2021, as detailed in an Avalere study. By 2022, only 44% of doctors owned their practices, a sharp drop from 76% back in the early 1980s, as reported by the American Medical Association. Reasons like decreasing payments, soaring operational expenses, and increasing medical debts are making it increasingly difficult for doctors to maintain their independence.

As the statistics starkly illustrate the shift from private practice to employment, it's important to consider how these changes affect the day-to-day lives of physicians. Many doctors report feeling the impact profoundly, as the trend towards employment often translates into reduced clinical autonomy and a shift in focus from patient care to corporate profitability. This growing sentiment among physicians highlights the personal and professional challenges that come with this significant shift in the healthcare landscape.

In this article, we explore how to navigate the changing medical landscape while striving to retain some measure of control over their professional lives.

Realities of Modern Physician Employment

Leaders are increasingly worried about the diminishing autonomy many physicians are experiencing as healthcare becomes more corporatized. According to Medscape's "Employed Physicians Report 2023," 56% of employed physicians dislike their diminished autonomy, a significant rise from 48% the previous year.

A large number of these physicians feel that corporate ownership restricts their clinical independence. A survey by NORC at the University of Chicago revealed that 61% of them have limited freedom to make referrals outside their ownership systems, and 47% often modify patient treatments to cut costs in line with corporate policies and incentives.

This shift exposes physicians to the caprices of large corporations, eroding their control over their practices and weakening their relationships with patients. Sixty percent of physicians believe that practices owned by non-physicians lead to poorer patient care quality.

In such environments, physicians find themselves with minimal input into their patients' care. Business managers often pressure them to increase profitability—seeing more patients per hour, boosting billings, and enhancing in-house referrals—all while maintaining high patient satisfaction scores, even at the cost of not reporting aggressive patients.

Physicians in corporate settings report reduced patient interaction time and an overwhelming focus on financial performance as the primary detractors from care quality.

Conversely, physicians in private practice enjoy more freedom to offer personalized care. They are not tied to hospital directives and can refer their patients to whoever they deem best, emphasizing the importance of the doctor-patient relationship.

According to recent findings from consulting firm Avalere, backed by the Physicians Advocacy Institute, nearly 80% of physicians are now employed by hospitals, health systems, or other corporate bodies.

These corporate entities are increasingly dominating physician practices, transforming American medicine with minimal regulatory oversight. While physicians prioritize patient health, corporate bodies focus on profit, sometimes at the expense of optimal care.

Further highlighting this trend:

• From 2012 to 2024, the percentage of physicians employed by hospitals and health systems soared from 25.8% to 55.1%.
• Between 2022 and 2023, another 19,100 physicians became hospital or corporate employees—a 5.1% increase from the previous year.
• Over the same period, hospitals and other corporate bodies acquired 8,100 more physician practices, marking a 6% increase.

However, the viability of leading a private practice often depends on the geographic location of the physician, underscoring the regional variations in the ease of maintaining independence.

State-by-State Analysis: Best and Worst Places for Physician Practice

The increasing dominance of corporate entities in healthcare does not affect all regions uniformly. In states where corporate control is more pervasive, physicians often face greater constraints on their practice, impacting their autonomy and the quality of care they can provide. This variability is crucial in understanding why some states emerge as more favorable for medical practices. States offering more professional independence and fewer corporate intrusions tend to create environments where physicians can thrive, directly influencing their desirability as places to practice medicine.

According to a detailed report from WalletHub, Montana ranks as the best state for physicians to practice, offering an environment that supports professional independence and quality care. Conversely, Hawaii is noted as the worst, where conditions may hinder physician autonomy and satisfaction.

This evaluation spans all 50 states and Washington, D.C., assessing them based on opportunity for growth, competitive environment, and the overall medical setting. These aspects are further dissected into 19 specific metrics, such as the average annual wage for physicians, the density of hospitals, and physician burnout rates—factors that significantly affect a physician's ability to maintain autonomy and deliver patient-centered care.

The states that provide the most favorable conditions for medical practice include:

• Montana
• South Dakota
• Nebraska
• Utah
• Indiana
• Minnesota
• Wisconsin
• Idaho
• Iowa
• Louisiana

On the other hand, the states where physicians may face more challenges, potentially impacting their autonomy and overall job satisfaction, are:

• Hawaii
• Rhode Island
• New Jersey
• Massachusetts
• New York
• New Mexico
• District of Columbia
• Oregon
• Illinois
• Alaska

This geographical variability underlines the stark differences in practicing medicine across the United States, which can significantly influence where physicians choose to work, based on their desire for independence and the quality of care they wish to provide.

Top Five States for Physician Employment: A Closer Look

The states with the highest employment rates for physicians are not just indicators of where demand for medical services is greatest; they also reflect the broader employment trends that can affect physician autonomy and the overall conditions of their practice. In these populous states, high employment often comes with more structured healthcare systems, which can impose additional constraints on how physicians operate. Understanding these dynamics is key to comprehending what high employment rates mean for physicians working in these areas—often they must navigate more complex systems that may prioritize organizational goals over individual physician autonomy.

Texas leads the nation with the highest number of employed physicians, a testament to its large population and expansive healthcare system. The Bureau of Labor Statistics provides data that ranks the top five states by the number of employed physicians, offering insights into where the demand for medical services is greatest. Notably, this dataset excludes specialists such as anesthesiologists, cardiologists, and others, focusing instead on a broader category of medical professionals.

Here’s a breakdown of the states with the highest employment of physicians:

• Texas: 28,660
• California: 25,890
• Pennsylvania: 21,700
• Florida: 20,490
• Ohio: 18,810

Compensation Trends for Physicians Across the U.S.

North Dakota emerges as the state with the highest average pay for physicians, which can be an attractive proposition for medical professionals looking for financially rewarding opportunities. This salary data, provided by the Bureau of Labor Statistics, specifically excludes several specialties like anesthesiologists and cardiologists, focusing on a broad swath of other medical fields.

This information is significant because compensation is a critical factor that influences not only where physicians decide to practice but also their decision to either join larger healthcare systems or maintain independent practices. States offering higher pay might better support physicians who wish to remain independent, as financial stability can cushion against the pressures of operating costs and administrative burdens that are often lesser in employed settings.

The average annual wage of physicians in each state and Washington, D.C.:

• Alabama: $255,630
• Alaska: $284,240
• Arizona: $207,570
• Arkansas: $221,690
• California: $249,660
• Colorado: $323,020
• Connecticut: $310,050
• Delaware: $225,650
• District of Columbia: $239,820
• Florida: $288,67
• Georgia: $268,510
• Hawaii: $304,140
• Idaho: $292,750
• Illinois: $212,250
• Indiana: $323,030
• Iowa: $257,940
• Kansas: $230,000
• Kentucky: $316,730
• Louisiana: $306,030
• Maine: $257,340
• Maryland: $210,950
• Massachusetts: $229,980
• Michigan: $204,730
• Minnesota: $302,110
• Mississippi: $288,480
• Missouri: $300,040
• Montana: equal to or greater than $239,200 per year.
• Nebraska: $309,310
• Nevada: $256,770
• New Hampshire: $315,630
• New Jersey: $204,450
• New Mexico: $302,650
• New York: $227,910
• North Carolina: $218,010
• North Dakota: $351,270
• Ohio: $271,040
• Oklahoma: $243,060
• Oregon: $288,930
• Pennsylvania: $187,330
• Rhode Island: $204,520
• South Carolina: $326,530
• South Dakota: $296,490
• Tennessee: $297,780
• Texas: $239,840
• Utah: $228,640
• Vermont: $270,230
• Virginia: $209,170
• Washington: $288,560
• West Virginia: $263,850
• Wisconsin: $288,500
• Wyoming: $339,540

Ranking Physician Salaries: Highest-Paying Specialties in Medicine

The disparities in pay across various medical specialties play a crucial role in shaping physicians' career choices and influencing their professional autonomy. Higher-paying specialties often come with different work environments and expectations that may affect a physician's ability to operate independently. This ranking is instrumental in understanding why physicians might gravitate towards certain specialties that offer higher compensation, potentially at the cost of lesser autonomy if these fields are predominantly located within larger healthcare systems that offer more structured and regulated environments. Conversely, lower-paid specialties might see a higher rate of physicians opting for private practice, seeking more control over their work and patient relationships despite the financial trade-offs

According to Medscape's "Physician Compensation Report 2024," orthopedics ranks as the highest-paying specialty. This annual report gathers responses from 7,000 physicians across 29 specialties, offering a comprehensive view of the financial landscape in the medical profession.

Here are the specialties ranked from highest to lowest pay:

• Orthopedics: $558,000
• Plastic surgery: $536,000
• Cardiology: $525,000
• Urology: $515,000
• Gastroenterology: $512,000
• Radiology: $498,000
• Dermatology: $479,000
• Anesthesiology: $472,000
• Oncology: $494,000
• Otolaryngology: $459,000
• General surgery: $423,000
• Ophthalmology: $409,000
• Critical care: $401,000
• Pulmonary medicine: $397,000
• Emergency medicine: $379,000
• Pathology: $366,000
• Obstetricians and gynecologists: $352,000
• Neurology: $343,000
• Nephrology: $341,000
• Physical medicine and rehabilitation: $341,000
• Psychiatry: $323,000
• Allergy and immunology: $307,000
• Rheumatology: $286,000
• Internal medicine: $282,000
• Family medicine: $272,000
• Public health and preventive medicine: $263,000
• Infectious diseases: $261,000
• Pediatrics: $260,000
• Diabetes and endocrinology: $256,000

The Critical Role of Medical Credentialing in Practice Management

Navigating both the opportunities in more supportive states and the challenges in restrictive ones, physicians must actively engage with legal regulations. This responsibility holds true regardless of whether they operate in private practices or within larger organizations, as both must adhere to the same legal and public obligations. Among the practical steps physicians can take to navigate the complexities of healthcare systems—physician credentialing emerges as a crucial strategy.

• Quality Assurance

Credentialing involves a detailed verification of a physician’s background, including education, work history, and other qualifications. This ensures that new hires are well-qualified for their roles, enhancing the overall quality of care provided by the practice. Besides, both, patients and insurance companies prefer credentialed doctors and practices, acknowledging their proven competence to uphold specialty-specific standards.

• Patient Safety

Credentialing ensures that medical professionals possess the requisite experience and skills to safely perform medical procedures, thereby minimizing the risk of errors by unqualified practitioners. This process reinforces patient trust in the medical practice, knowing that their care providers are verified and competent.

• Prevented Revenue Loses

Accurate credentialing safeguards against significant revenue losses due to delayed or denied insurance reimbursements. If errors occur in the credentialing process, insurers might withhold payments for services rendered, although they may retroactively cover treatments if credentialing is finalized during treatment.

• Increased Patient Base

Credentialing expands a practice’s access to a broader patient base by enabling acceptance of insured patients. Given that a vast majority of Americans are covered by health insurance, credentialing can significantly enhance a practice’s client flow and revenue potential.

• Improved Reputation

In an era where patients frequently research medical providers online before scheduling visits, being credentialed enhances a practice’s reputation. Visible credentials assure potential patients of a practice’s legitimacy and reliability.

• Deliver a Competitive Edge

In the competitive healthcare market, practices need every advantage they can get. Credentialing not only attests to the expertise of the physicians in a practice but also attracts high-caliber medical professionals seeking affiliation with credentialed institutions, thereby fostering growth and ensuring a high standard of care.

Through credentialing, practices can establish and scale their operations effectively, building trust with both patients and insurance providers. These trustworthy relationships are instrumental in enhancing revenue, which in turn supports the preservation of autonomy. Credentialing empowers practices to maintain their independence and thrive even amidst the challenges of changing regulations and market dynamics.

Transform your Medical Practice Credentialing with Credsy

Credentialing is a vital component in delivering top-tier patient care and securing a competitive edge in the healthcare industry. Although the benefits are significant, it's essential to acknowledge the potential challenges, such as the time-consuming nature of the process and the complexity of managing extensive documentation.

Credsy simplifies this intricate process, enabling you to manage credentialing with the proficiency of a seasoned expert from the start. Our software features a user-friendly interface equipped with real-time analytics that are easy to understand. We ensure seamless integration with CAQH, and our role-based permission settings are clear-cut, perfect for practices focused on continuous operational enhancements.

With Credsy, you're not just adopting a tool; you're transforming how your practice handles credentialing. Our platform empowers you to make informed, data-driven decisions, significantly boosting your operational efficiency.

Don’t just take our word for it. Schedule a free demo today and see for yourself how Credsy can revolutionize your credentialing process and help you maintain the high standards your medical practice is known for.