Hospital employment was once billed as the solution to the headaches of private practice — a way to gain stability, reduce administrative burden, and focus on patient care. But for many physicians, that promise has come undone.

According to the Physicians Foundation’s 2024 report, 60 percent of physicians report frequent feelings of burnout — the highest level on record. Instead of feeling supported, many employed physicians feel overworked, undervalued, and constrained by systems that prioritize efficiency over autonomy.

Why physicians embraced employment

The move toward hospital and corporate employment accelerated in the 2010s, driven by mounting regulatory complexity, rising overhead, and shifting payment models. For many physicians, a salaried role with benefits seemed like a safer, easier path than running an independent practice.

Larger health systems promised:

• Steady pay and benefits
• Fewer administrative responsibilities
• Better work-life balance

Economic and policy changes, like the Affordable Care Act and EHR mandates, made it harder for small practices to survive. Many physicians felt they had no choice but to sell or join a system.

At the time, it felt like a relief. But for many, it came at a steep cost.

Erosion of physician autonomy

A recent survey of over 3,500 physicians revealed that 67 percent of those in independent practice reported having ‘significant autonomy’ in clinical decision-making, compared to only 38 percent in hospital-employed positions. That autonomy matters — and it is slipping away.

Employment has been one of the primary drivers in this loss of physician autonomy. Clinical decisions are often influenced — or outright dictated — by non-clinical administrators focused on cost and efficiency. Time with patients is shortened, protocols are rigid, and referrals are restricted to in-network providers.

Physicians also lose control over their schedules and workloads. Many are expected to meet RVU quotas, take on heavier patient loads, or adhere to inflexible call schedules — all with limited input.

The result? Many physicians feel more like employees than independent professionals — disconnected from their purpose and unable to fully advocate for their patients. Beyond autonomy, physicians are also finding that hospital employment might not deliver the financial security they initially expected.

Financial stability: Not what it seems

While employment offered a steady paycheck, many physicians are discovering it may not be the best path to financial growth.

• Private practice physicians earn 10 percent more on average, according to a 2024 article from MedCoShare.
• Over a typical 30-year career, private practice physicians earning an average of 10 percent more annually can accumulate approximately $1 million more in lifetime earnings compared to their hospital-employed counterparts.

In contrast, employed physicians face capped compensation, ever-shifting RVU formulas, and no equity. They build value for the system — but do not share in the ownership or long-term financial benefits.

And the job itself is not as secure as it seems. Physicians can be laid off, relocated, or contractually restricted from working nearby due to non-compete clauses. The financial “safety net” of employment has proven to be thinner than expected. Financial challenges are not the only issues physicians face — rising burnout and declining job satisfaction further compound their frustrations.

Job satisfaction and burnout

Physician burnout has surged alongside the rise of employment. Medscape’s 2025 Physician Mental Health & Well-Being Report reveals that roughly half of physicians feel burned out and/or depressed. What was supposed to offer relief has, in many cases, made the problem worse.

While employed physicians were once promised better work-life balance, the reality is mixed. A 2023 Medscape report found only 22 percent of employed physicians report liking their work-life balance. And the same 2025 Medscape report found that 63 percent of physicians would accept a pay cut for better work-life balance.

Combined with loss of autonomy, tight scheduling, and system-driven pressure, it is no wonder job satisfaction is falling. Many physicians feel disconnected from their purpose, contributing to emotional exhaustion and turnover. Faced with diminishing autonomy, financial constraints, and increasing burnout, many physicians are now seeking alternatives to regain control.

Is there a better way forward?

More physicians are exploring alternatives that restore control and meaning to their work.

Private practice is making a quiet comeback — from concierge models to lean, tech-enabled practices. These models offer:

• Greater flexibility
• Personalized care delivery
• Higher income potential
• More aligned professional values

And patients benefit, too. Research consistently shows that continuity of care in private practice settings is associated with higher patient satisfaction and improved health outcomes.

With the right support — including legal, financial, and operational guidance — physicians can transition into models that offer both autonomy and sustainability.

So what’s next?

The shift to hospital employment was supposed to bring security and freedom. For many, it has delivered just the opposite.

Physicians are now reevaluating what matters most — autonomy, financial control, and meaningful patient care. While the system may not change overnight, individual physicians can take steps to reclaim agency in their careers.

The profession may be changing, but the mission remains the same: Practice medicine with purpose, integrity, and freedom.

Justin Nabity is a certified financial planner.