More Healthcare Professionals Choose Employment With Organizations Over Self-Employment

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In recent years, more healthcare professionals are choosing to work for organizations rather than starting their own practice.

According to a study published in JAMA Network Open, since 2001, the percentage of healthcare professionals who are self-employed shrank, and the disparity in earnings between self-employed healthcare professionals and those employed by for-profit or nonprofit organizations diminished.

In recent years, more healthcare professionals have chosen to work for organizations rather than starting their own practice. Kamyar Nasseh, PhD, and Marko Vujicic, PhD, of the Health Policy Institute at the American Dental Association in Chicago, Illinois, extracted data from the American Community Survey study to evaluate trends in self-employment and employment and to gauge the gap in annual earnings between these 2 groups of healthcare professionals between 2001 and 2015. They evaluated trends over 5-year segments: 2001 to 2005, 2006 to 2010, and 2011 to 2015. The authors used median regression models to measure the gap in annual labor earnings between self-employed and employed professionals.

The authors compiled a sample of 175,714 respondents, including physicians, dentists, pharmacists, optometrists, chiropractors, podiatrists, and physical therapists who worked at least 20 hours per week and 40 weeks or more per year. The weighted percentage of self-employed physicians decreased from 35.2% between 2001 and 2005 to 24.7% between 2011 and 2015. For dentists, self-employment decreased from 73% between 2001 and 2005 to 65.1% between 2011 and 2015.

The regression-adjusted earnings gap between self-employed and employed physicians reversed from $19,679 between 2001 and 2005 to -$10,623 between 2011 and 2015, with employed physicians earning more than self-employed physicians during the latter period. The gap also reversed among pharmacists, optometrists, and podiatrists. Among dentists, these figures narrowed from $30,448 between 2001 and 2005 to $21,291 between 2011 and 2015. The earnings gap also narrowed among chiropractors and physical therapists.

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Drs Nasseh and Vujicic noted that more employed healthcare professionals belong to large provider groups than smaller groups. They suggested this may reflect the greater ability of these organizations to handle the complexities of today’s healthcare economy, which, in turn, may translate into higher incomes for healthcare providers.

The authors argued for more research to establish the drivers behind this trend and the shrinking earnings gap between employed and self-employed healthcare professionals.


Nasseh K, Vujicic M. Earnings of employed and self-employed US health care professionals. JAMA Networtk Open. 2018;1(2):e180431.

This article originally appeared on Medical Bag