Employed v Self Employed Physicians
What percentage of physicians are self-employed?
Let’s talk about the different types of employment relationships for a physician and how many are self-employed.
For any physician, you either have an employee, which is a W2, or an independent contractor, and that physician would receive a 1099.
Now, if you are an independent contractor, you are self-employed if you have an LLC and solely work as an independent contractor.
In contrast, you are not self-employed if you’re an employee for a hospital network, a larger privately owned physician group, or a conglomerate.
Now, regarding how many or what percentage of physicians are self-employed, let’s discuss the definition of self-employed.
What Does Self-Employed Mean?
Self-employed means you are a solo practitioner working independently without partners or having a shareholder percentage. If you are a solo practitioner, statistics show that around 14.8% of all physicians currently practicing in the United States are self-employed.
It seems like a relatively low percentage, but if you pay attention to the trends in the healthcare industry, there’s been an enormous push from these big hospital networks to gobble up all of these physician-owned practices and then integrate them into their systems.
So the percentage of self-employed physicians has continued to decrease over time.
At one point, it was between 30% to 40% 20 years ago. And now, it just slowly reduced over time.
Is that a bad thing? I don’t think it’s bad or good.
The Benefits of a Solo Practice Brought By Big Hospital
I think the benefits of, if you’re in solo practice to being bought out by a big hospital network are, one, they’re going to drop the bag, so you’re going to get paid, or at least you should get paid a decent amount of money to sell your practice to the hospital network. But I find the practical advantage for most physicians is they no longer must deal with the oversight of the practice.
So, I do all the administrative duties, all the things that are the headaches of being a small business owner, and what I deal with weekly, just worrying about payroll and insurance and dealing with the lease. I also pay for the internet, electricity, and the finances with the bookkeeping. All that is taken away from you if you’re a self-employed physician. Then you sell out to a larger group or hospital network. Many physicians love not having those responsibilities.
The Downside of Not Being a Self-Employed
The downside is that you will likely make less money as a physician if you are not self-employed. If you’re self-employed, you can do things exactly how you want them. They can be more efficient. You can hire as many people as you wish and compensate them in the exact way you want to pay them.
Many self-employed physicians can do very well for themselves. Some physicians are not that good at business, which would benefit any profession. Some people, lawyers included, are great at their job but might not be the best businessperson.
And so, identifying a physician’s strengths and weaknesses and then determining what type of employment structure best suits them is undoubtedly essential. Around 15% of all physicians are currently self-employed.
It ebbs and flows over time. When I started law school around 20 years ago, most big hospital networks were buying practices. And then, five years later, they started investing in them. So, it ebbs and flows over time. But right now, we’re in a stage where these big hospital networks are gobbling up all these smaller physician-owned practices.
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What Are Different Types of Physician Contracts?
What are the different types of contracts physicians can sign?
There are two: You have an independent contractor agreement. Then, you have the employment agreement.
So, what are the differences between the two?
An employment agreement means an employer and the physician an employee. They are a W-2 employee, meaning tax deduction is out of their compensation. And then, the employment agreement will go through the general terms of the relationship:
- How long does the contract last?
- How is it terminated?
- The process of compensation
- The liability insurance
- Restrictive covenants
- Non-compete
- Non-solicit
That type of thing. In an independent contractor agreement, you are not a W-2 employee. You’re a 1099 employee. That means no tax deduction of whatever the physician received via compensation.
Physicians Being an Independent Contractor
The physicians will be responsible for paying their taxes quarterly at the end of the year. Another big difference is for most independent contractor agreements.
The physicians will be responsible for all of the ancillary costs associated with the practice:
- Medical license
- DEA, registration
- Professional associations
- Privileging and credentialing
- Malpractice insurance
- Whether they have to pay tail insurance
Those things are generally the cost of the independent contractor, not the person they’re working with. Sometimes, the employer utilizing the independent contractor will pay for certain things.
Still, another key point is that an independent contractor rarely gets benefits. Health, vision, dental, disability, life insurance, and retirement are unavailable. So, why would someone, if given a chance, choose to be an independent contractor?
Employment Agreement From the Practice
The entire point of an independent contractor agreement is that it’s easy to get into and out of a contract. And theoretically, the independent contractor should be able to make their schedule work when they want that type of thing.
However, that doesn’t honestly happen very often. An independent contractor, if they’re smart, they’ll create an LLC. Then they’ll have some money paid and set up a bank account.
They can expense all of those things I talked about previously. Most employers don’t know if force is the right word. They only offer the independent contractor agreement option. Maybe they’re not solely doing that, but they’re doing it often to avoid paying employment tax to the physician.
An independent contractor agreement for physicians does not have many benefits. A long notice is a requirement to terminate the agreement if it still includes restrictive covenants.
Physician Employment Contract Depending on Specialties
As I said, they don’t get paid benefits or other licensing.
Let us take anesthesiologists and dermatologists. Those are specialties that frequently use an independent contractor. Some radiologists as well, but primary care, peds, cardiology, that type of thing, are almost always going to be employees. And then, if you are working for a hospital or healthcare network, 100% of the time, you’ll be an employee rather than an independent contractor.
Maybe you’re working at a hospital, but you’re working for a group contracted with the hospital to provide services. I guess that’s possible where you’d be an independent contractor, but it doesn’t happen often.
So, the two types of physician contracts are independent contractor agreements and physician employment contracts.
Can a Physician Be an Independent Contractor?
Occasionally, one question that comes up is, are physicians independent contractors?
The answer to that depends on what kind of contract you signed.
There are two types of arrangements for doctors. You have employment agreements and then independent contractor agreements. With an employment agreement, you’re an employee. Then the contract you signed will specify all the terms.
What the physicians need to do and what the employer needs to do. Then many of those terms are the same in an independent contractor agreement. Still, there’s much less detail in an independent contractor agreement for some employment agreements.
Let’s briefly go through the two, and then we’ll get back to when a doctor is an independent contractor.
Independent Contractor Agreement for Doctors
The main differences are one, in an employment agreement. The physicians receive payment via W-2. Then, the employer will pay for most of the things necessary to be a doctor:
- Licensing
- DEA registration
- Credentialing
- Privileging
- Practice insurance
- Any expenses associated with being a doctor.
You’re not receiving payment as a W-2 employee in an independent contractor agreement. Your payment is via 1099. The doctor must take out the taxes when they file their returns. Then, primarily, the entity contracting with the independent contractor won’t pay the dues, fees, and other expenses. So, physicians will be the one that pays for the license, DEA, and continuing medical education. There are also no benefits associated with an independent contractor agreement generally.
So employers won’t provide health vision, dental, life, disability, retirement, and all that stuff to the independent contractor.
Another question is, what’s better for me, and what’s the point of both?
I find it’s very specialty-dependent. Anesthesiologists and dermatologists have more independent contractor agreements than any other specialties. Suppose physicians are self-employed. Then, they’re essentially taxed as an independent contractor, although they would not receive 1099.
Medical Practice Tax Considerations
Some practices only utilize independent contractor agreements to avoid paying employment taxes. These are quasi-employment agreements. The doctors kind of act like employees, their schedules set for them. They’re using the employer’s facilities and supplies, and staff.
However, if physicians aren’t independent contractors, they would generally create an LLC. Then they would run all of the payments through the LLC bank account.
They would also be able to deduct the expenses. I went through all the things before licensing CME, malpractice, insurance, tail insurance, and all that kind of stuff as well. I had to weigh one versus the other.
Suppose the physicians do have the choice between the two. Then, it would depend upon whether the compensation structure would be worth accepting an independent contractor agreement.
Physician Employee or Independent Contractor?
If it’s based purely on net collections, sometimes it is more lucrative to be an independent contractor. Still, suppose I have to give a percentage of which way physicians ultimately benefit more. In that case, it’s probably like 80/20 employment agreements.
That’s because all the things the independent contractor has to pay for, which the employer provides, add up over time.
Then another thing to think about is some individual physicians can’t get some of the things that a larger employer can. It isn’t easy to get individual health insurance because it’s expensive. Then all the other things, vision, dental, life, disability, malpractice, and tail insurance, add up quickly.
Anyway, if a physician’s debating between the two, I wish I could give a better answer besides it. It depends, but that’s an overview of whether doctors are independent contractors. It just depends upon what kind of contract they signed.
Physician Independent Contractor vs Employee
There are considerations for physicians as employees versus independent contractors.
Let’s kind of break down both. If you’re an employee, you will receive a W2 at the end of the year. It just summarizes all the compensation you’ve received and then all the taxes that have been withheld. If you’re an independent contractor, you will not receive a W2 but a 1099 at the end of the year.
That’s just a summary of the compensation received from that business. No taxes are withheld as an independent contractor.
Let’s take the relationship between the two and start with when you’re an employee.
Dues and Fees Coverage Under W2
You will receive all the benefits of regular employment when you’re an employee. They’re going to pay for your malpractice insurance. The employer will pay for your health, vision, dental, life, disability, retirement, privileging, credentialing, and continuing medical education. They’ll probably provide you with moving expenses and another signing bonus. You get a lot of ancillary benefits as an employee.
Dues and Fees as 1099
As an independent contractor, you won’t get any of those things. They’re not going to pay for your dues or fees. They may pay for your annual premium for your malpractice insurance, but I find that’s hit or miss. It’s very rare if you have a claims-made policy that they would pay for tail insurance.
So, that’s something you’ll have to worry about as well. And then you’ll have to pay for all the other things. You’ll have to find your health, dental, and vision insurance. You get disability, life, you set up your retirement, whatever you decide which way to go. All of that falls upon the physicians if they’re 1099 independent contractors.
Maximizing the Deduction on Taxes of 1099
Now, for some, you come out compensation-wise. As for 1099, you can deduct all the things I just discussed. There are some tax advantages to being an independent contractor. I’m not a tax attorney; I won’t get into that specifics, but I suggest contacting an accountant with experience.
I can walk you through the most advantageous compensation/tax situation. It’s going to be very specific to the job. Suppose someone asks me if they potentially had the option of either being an employee or an independent contractor. In that case, one must take several factors into account.
I find it’s rare for it to be the option of the physicians. Usually, the position is either going to be this or that. It’s not up to you. I mean, it’s very rare when I review a contract that we have to discuss, alright, well, I do have two options and two contracts. Which way do you think I should go? Most physician-owned businesses don’t give the option to the physicians. It’s either one or another.
Common Mistakes of Independent Contractors
Now, you have two different jobs, one is an independent contractor, and one is an employee. Then you’ll have to determine what situation is best for you. But it depends upon the physicians. I find some physicians who work as independent contractors do some things wrong.
One, they don’t know where to get what an average employer would provide them. So, all those insurances and retirement and that type of thing are just not the type of person who is good at handling that side of their life.
Two, with no taxes being withheld from your compensation. I find many of them spend what they get. Then, either they’re not giving their quarterly payments to the government or year-end. They have an enormous tax bill that they were maybe shocked that they have to pay out. So, suppose you are going to be an independent contractor.
In that case, you need to be on top of it. I need to withhold or set aside this amount from each paycheck I get from the business. That way, you’re not screwed in getting all the money that needs to be paid for your taxes annually.
Being an employee is safer and more secure than being an independent contractor.
Required Notice Period
Usually, the notice required to terminate the agreement is shorter for an independent contractor. That means either party can get out of the agreement with little notice. Now, as physicians, continuity of care always has to be considered.
Suppose you’re an independent contractor unless you are in a specialty where it’s just like shift work or maybe if you’re in anesthesia. You pop in, do the case and leave. But suppose you are a physician with a patient base, and you’re providing care to them if you tell your employer, hey. In that case, I’m not coming in tomorrow. Some continuity of care issues could lead to board complaints or other problems. So, that needs consideration as well.
What is the notice required to terminate the contract?
It’s usually 60 to 90 days if you’re an employee. In contrast, if you’re an independent contractor, you don’t see many notice periods of less than 30. Still, sometimes it might be as low as two weeks for an independent contractor agreement.
So, that’s a little breakdown between being an independent contractor and an employee as a physician.
As I said before, you need to look at the situation. Then, determine that compensation-wise doesn’t make the most sense considering the tax deductions and that type of thing.
Is a Physician an Independent Contractor? | Medical Doctor
One question that comes up occasionally is, are physicians independent contractors?
The answer to that depends on what kind of contract you signed. There are two types of contracts for doctors. You have employment agreements and then independent contractor agreements. With an employment agreement, you’re an employee. The contract you signed will specify all the terms—what the physicians need to do and what the employer needs to do. Then many of those terms are the same in an independent contractor agreement.
Still, there’s lesser detail in an independent contractor agreement for some employment agreements.
Let’s briefly go through the two. Then we’ll get back to when a doctor is an independent contractor.
Independent Contractor Agreement for Doctors
The main differences are that in a physician employment agreement, the physician receives payment via W-2. Then, the employer will pay for most of the things necessary to be a doctor:
- Licensing
- DEA registration
- Credentialing
- Privileging, Practice Insurance
- Expenses associated with being a doctor.
You’re not receiving payment as a W-2 employee in an independent contractor agreement. You receive payment via 1099. That means the doctor must take out the taxes when they file their returns. Then, most of the time, the entity contracting with the independent contractor will not pay for the dues, fees, and other expenses.
So, the physicians will pay for the license, DEA, and continuing medical education. There are also no benefits associated with an independent contractor agreement generally—so health, vision, dental, life, disability, and retirement.
The employer won’t provide all that stuff to the independent contractor.
Another question is, what’s better for me, and what’s the point of both?
I find it’s very specialty-dependent. Anesthesiologists and dermatologists have more independent contractor agreements than any other specialties.
Medical Practice Tax Considerations
Some of these practices only utilize independent contractor agreements.
That is because they can avoid paying employment taxes.
These are quasi-employment agreements. The doctors kind of act like employees, their schedules set for them. They’re using the employer’s facilities and supplies, and staff. However, if a physician isn’t an independent contractor, they would generally create an LLC.
Then they would run all of the payments through the LLC bank account. They would also be able to deduct the expenses. I went through all the things before licensing CME, malpractice, insurance, tail insurance, and all that kind of stuff as well.
Suppose I had to weigh one versus the other. If the physicians do have the choice between the two, it would depend upon the compensation structure. That is, whether accepting an independent contractor agreement or not. If it’s based purely on net collections, sometimes it is more lucrative to be an independent contractor.
Still, suppose I have to give a percentage of which way physicians ultimately benefit more. In that case, it’s probably like 80/20 employment agreements because all the things the independent contractor has to pay for, those provided by the employer, add up over time.
Then another thing to think about is some individual physicians can’t get some of the things that a more significant employer can. It isn’t easy to get personal health insurance because it’s expensive. Then all the other things, vision, dental, life, disability, malpractice, and tail insurance, add up quickly. Anyway, if a physician’s debating between the two, I wish I could give a better answer besides it.
It depends, but that’s an overview of whether doctors are independent contractors. It just depends upon what kind of contract they signed.
Can You Break a Physician Contract? | Physician Contracts
So, can you break a physician’s contract? I daily deal with physicians with new employment agreements that need review. Or are on a current agreement that they need to analyze, usually due to wanting to terminate it.
Like the base level, one reasonably frequent question is whether you can break a physician’s contract. I think defining break is probably the essential part of that.
So, can you break a physician’s contract?
If breaking means breaching the contract, not following through on the terms of the agreement? Sure, you can.
How to Terminate Physician Employment Agreements
But then you would open yourself up to liability. You could get sued, and litigation could begin. If there’s an arbitration clause, then it could go to arbitration. The employer could come after you for damages, recruitment fees for new physicians in practice, and lost revenue from you. You are leaving extra admin fees if there’s no physician to support.
Can you breach a contract? You can, but it’s certainly not a good idea.
For this blog, if we’re going to say, can I break a physician contract? I think the best way to handle that would be to terminate the contract. And indeed, yeah, you can. At least every physician employment contract will have a termination section. And in that section, it will dictate the terms of how the physician can terminate the agreement.
There are usually three ways: First, by mutual agreement. If you and the employer agree, the check gets terminated. And you can work out how long the physician will stay, but that only happens sometimes. The second way to end a contract is with-cause. It goes both ways. For the most part, most of these employment contracts are highly slanted toward the employer as far as what they can fire the physician for.
And honestly, most contracts are entirely silent on what the physician can do if the employer breaches the contract. Some typically think that the employer can terminate a physician immediately for cause at their option. So, the physician loses the license, DEA registration, they’re running shareable, they’re on the OIG list, those types of like obvious, right?
Chelle Law
Chelle Law will provide a physician contract review to identify the areas that can improve and assist you in negotiating the best contract possible.
Considerations to Make When Breaking a Contract
If you can’t practice as a doctor, you can’t fulfill the terms of the contract. The employer can fire the physician immediately from practice for that.
The most critical section is, can a physician break a contract?
Assuming break means terminate, there should be a without-cause termination section. That section typically states that the other party can terminate the agreement with a certain amount of notice.
I’d say the industry-standard amounts are between 60 to 90 days. So you would give the employer notice as it’s written. And there’s also a notice section that says how to provide adequate notice. So you’d write them a letter and then go through the notice section properly, usually certified mail, hand delivery, and not very often, email.
If you verbally tell your boss, Hey, I’m leaving. That won’t be adequate notice. So, if it’s 60 or 90 days, you give them 60 days’ notice.
Now, there are some considerations.
However, if you break the agreement, terminate the agreement. In this case, if you’re a new physician in practice and received a signing bonus or relocation, there’d usually be some forgiveness in the first couple of years. If you leave before the initial term, you must repay some of the signing bonus and relocation assistance.
The second consideration is whether you must pay for medical tail insurance? Most contracts, at least for the smaller physician-to-own groups, will have some clause. That states that if the physician in practice terminates the agreement without cause, they’ll be responsible for paying for medical tail insurance.
Details that Physician Needs to Know After Termination
If you don’t know what medical tail insurance is, I have some other videos you can watch. The last consideration is the restrictive covenants that will apply if you terminate the contract without cause. Those restrictive covenants are going to apply.
Restrictive covenants would be the non-compete notes. It is non-disparagement, like everything you can’t do after the contract ends. Just because you terminate an agreement doesn’t mean you don’t have responsibilities or obligations once the agreement ends.
In summary, yes, a physician can break a contract. Still, I suggest doing it properly, as written in the termination section. And then, once you decide to terminate, you have to think about all the kinds of things that you’ll be responsible for. Another thing that came to mind is that the contract will also state the payment responsibilities after the contract ends.
I just had something like this come up yesterday. They were on a net-collections compensation structure. Meaning paid what was collected, but the contract stated they would only get paid through the end of the termination date. With a standard 90-day accounts receivable cycle and getting reimbursed for claims, the physician missed out on 90 days of collection.
If you think of it this way, they almost worked for free for the last two or three months, which nobody wants to do. Physicians need to be cautious if they’re on a net-collections model. It states there’ll be some collection period after the contract terminates, so they don’t lose all that money. I mean, it’s sled towards the employer.
Physician Practice Contract Review
It’s unfair, but many physicians don’t consider that when the contract is terminated. Hopefully, this is helpful. If you’re a physician and have a question about your current contract or a new employment agreement, I’m happy to look at it. Take care.
Top 9 Physician Employment Statistics (2022 United States)
COVID-19 and the associated community mitigation efforts transformed the delivery and access to healthcare across the United States. The pandemic necessitated reforms that could improve the ability of the healthcare system.
That is not only to cope with future pandemics but also to meet the primary healthcare needs of Americans more effectively. An integral measure to improve healthcare preparedness and service delivery is urgently filling the projected shortage of crucial healthcare professionals, including physicians.
New data published by AAMC (Association of American Medical Colleges) reveals that the United States could see a projected shortage of 37,800 and 124,000 physicians by 2034, affecting primary and specialty care. Physicians play multi-faceted roles in the US healthcare sector. Suppose you are considering a career as a physician.
You need to keep up to date with the latest changes. This blog post looks at the current physician employment statistics.
If you have any questions or concerns about your employment contract, our physician contract review team at Chelle Law can help.
1 Million: The Number of Professionally Active Physicians in the Us
Statista estimates that as of September 2021, there were about one million physicians in service in the USA. Additionally, active specialist physicians totaled 552 310 in the same period under study. The US states with the most active physicians include California, New York, and Texas. In most medical specialties, female physicians are outnumbered by their male counterparts. They earn less than their counterparts in both primary care and specialty settings.
Ranked No.3: Physicians Made the Top 10 Of “100 Best Jobs” in 2022
US News and World Report ranked physician practice number 3 in the 100 best jobs survey 2022. Physicians are undoubtedly ubiquitous in the medical world. They leverage their expertise to examine, diagnose and treat patients. Physicians practice medicine in every healthcare setting, from emergency rooms and hospitals to private practice. They also care for patients in all specialties, from primary care and pediatrics to geriatrics and palliative care.
Hospitals, Physician Offices, And Other Healthcare Professionals Are Among the Top Places Hiring Physicians in 2022
Physicians are employed in diverse healthcare settings, including hospitals, clinics, private offices, and outpatient centers. In 2022, more physicians will practice in groups or healthcare organizations that provide backup coverage while allowing more time off. Surgeons typically work in hospitals or surgical outpatient centers. Many physicians also work in research laboratories, medical schools, and Veterans Administration hospitals.
1200 To 1900: The Number of Patients Most Primary Care Physicians See in a Year
Currently, the panel size for physicians in the US is 1200 to 1900 patients per year. It is down from a figure of 2300 in 2005. Smaller patient panel sizes allow primary care physicians to focus more on each patient, giving them individualized attention. It enables the physician to coordinate care, especially for patients with chronic or complex conditions.
51 Hours: The Average Number of Hours Physicians Work Per Week
A 2018 study by the Physicians Foundation shows that doctors, on average, work 51 hours a week and see about 20 patients daily. They dedicate almost 25% of their time to nonclinical paperwork.
However, it’s essential to note the number of patients to whom a doctor can offer quality care. Without compromising their well-being or job satisfaction depends on how doctors can delegate many tasks.
$208,000: The Median Salary Amount that Physicians Make in a Year
As of 2020, the best-paid physician made a median salary of $208,000, while the lowest-paid earned $126,470. In 2021, virtually all physician specialties saw an income increase as the demand for their services rose sharply due to the complications of COVID-19. Otolaryngology saw the most significant growth, at 13%.
At the same time, critical care physicians, which bore the biggest brunt of the pandemic, realized a meager 1% increase. As of 2022, plastic surgery remains the highest-paid specialty at an annual compensation of $576,000, with physicians in public health and preventive medicine taking the least yearly wage at $243,000.
Self-employed physicians in private practice generally have a higher median income than salaried physicians. However, self-employed physicians must cover the cost of practice insurance, health insurance, and retirement.
Job Outlook: 22,700 Openings for Physicians Each Year
The overall employment of physicians would grow by 3% each year from 2020 to 2030. This statistic translates to about 22,700 job openings for physicians and surgeons annually for this decade. Most of these openings will likely result from a need to replace workers who exit the labor force, retire or transfer to other occupations.
Most In-Demand Physicians: Primary Care Physicians
Primary care physicians include internal medicine, family medicine, geriatrics specialists, and pediatrics. The professionals provide the primary resources, including prescribing medicines, conducting routine physicals, treating minor illnesses, and managing chronic conditions. The second most in-demand physicians are internists.
These physicians diagnose and perform non-surgical treatments of various diseases and internal organ injuries like heart disease or diabetes. Emergency medicine physicians are also among the most in-demand professionals. Others are psychiatrists and physicians who diagnose and treat mental, emotional, and behavioral disorders.
Race And Ethnicity: 13.7% of Active Physicians Are of Unknown Race
A 2018 diversity report from AAMC shows that among active physicians, 56.2% are identified as White; 17.1% are identified as Asian, and 5.8% are Hispanic. There are only 5.0% of identified Black or African American.
Women constituted a more significant proportion than men among African American physicians. However, the males were more than the females in all the other groups—5.7% of Asian physicians and 60.1% of Alaska Native or American Indian physicians. Then, 65.5% of White and 59.5% of Hispanic physicians were male.
Chelle Law Can Help You Negotiate a Better Physician Contract
COVID-19 has exposed several disparities in health and access to healthcare services in the USA. The pandemic has highlighted physicians and other healthcare providers’ crucial role in our nation’s healthcare infrastructure. Consequently, the need to ensure we have enough physicians to meet America’s needs has never been so urgent.
At Chelle law, our physician contract attorneys can help you review your contract. Identifying areas that need improvement to ensure you sign the best contract possible.
Contact us today to learn more about our physician contract review solutions and other practice areas.
