The decision between ownership and employment remains one of the most critical career choices for physicians, particularly as reimbursement strains and practice costs push some in the workforce toward employed models. 

Jeremy Shiner, founder and CEO of Myriad Systems, a technology and software company that provides AI-driven practice management solutions, joined Becker’s to discuss the financial and operational challenges, key factors and long-term considerations in navigating this choice.

Over the last 20 years, practice costs have skyrocketed, Mr. Shiner said — including the cost of malpractice insurance, lawsuits, office space and medical equipment. Meanwhile, reimbursements are declining and patient payments are lower than ever.

“That paradigm keeps getting more and more and more lopsided against the profitable practice and that old sort of cliche that doctors make a lot of money has, sadly, somewhat gone away,” he said. 

For physicians deciding between employment and independent practice, autonomy is a major consideration. However, within large healthcare systems, autonomy is often limited.

“They want to be able to make their own decisions about healthcare interventions, medical equipment, pharmaceuticals and the overall path of care,” he said. “Yet a huge majority of physicians who enter large healthcare systems report being unhappy. And the number one reason they cite is lack of autonomy.”

According to a survey from consulting firm Bain & Co., nearly 25% of physicians in health system-led organizations are contemplating a change in employers, compared to just 14% in physician-led practices. Of those considering a switch, 37% are looking to move to physician-owned settings.

Additionally, 61% of employed physicians said they have moderate or no autonomy to make referrals outside of their practice or ownership system, and 47% said they adjust patient treatment options to reduce costs based on practice policies or incentives, according to a survey from NORC at the University of Chicago.

Additionally, while employment in a hospital or healthcare system offers stability, it lacks the same long-term financial upside as ownership.

“We often discuss how physicians in physician-led practices tend to earn slightly better salaries, but many statistics don’t fully address the earnings of the doctors who actually own and run those practices,” he said. “While it can be difficult to turn a profit, there’s significant potential — especially when it comes to building generational wealth. That opportunity disappears entirely if all physicians are employees.”

The need for hospital employees is still there, Mr. Shiner emphasized, but the financial opportunities are often lacking. 

“I’m not at all against hospital systems,” he said. “They do incredible work and save lives. But I also believe there’s room for both models. When we go too far toward one extreme, the weaknesses of that model start to become apparent, just as it happens in any industry.”

Beyond financial considerations, Mr. Shiner said independent practice allows physicians greater flexibility to explore new treatment methods, research opportunities and innovative care models. 

“Physicians want to explore new treatment methods, develop better ways to deliver care and make meaningful discoveries,” he said. “That’s much harder to do under the constraints of a corporate system with strict policies dictating what can and cannot be done.”

The balance between ownership and employment is a “shifting pendulum,” Mr. Shiner said. While the healthcare industry has leaned heavily toward consolidation and employment in recent years, there are signs of countertrends emerging.

“There’s always a swing in one direction, and then a swing back the other way,” he said. “That’s why I try not to overreact to these shifts, because at some point there’s always going to be a correction.”

Ultimately, Mr. Shiner emphasized that the decision between ownership and employment is a deeply personal one.

“As a provider, a business owner or a young doctor choosing a career path — or even an experienced doctor considering a change — you have to ask: Which side of that paradigm do I want to be on? What do I believe in? How do I want to practice medicine?” he said. “Hopefully, this choice is empowering and the outcome fulfilling.” 


Original article at Becker's Asc Review