Mosley says healthcare reform is demanding efficiencies of scale that solo or very small practices can't meet. "Compensation is down. Medicare and Medicaid are down. Some of these smaller groups are going to have to take all comers," he says. "Medicaid has always been tough but those state (health insurance) exchanges are going to be paid at Medicaid levels or less, and I don't see a lot of doctors except these solo guys taking it, which is going to mean less compensation."
In addition, he says, the initial cost hurdles to implement healthcare IT may be too high for smaller practices. "Even though they get their money back through the stimulus package, they can't afford to outlay that," Mosley says. "More importantly, they don't have the time to get trained on it."
Trending exactly in the opposite direction is the rise of physicians as hospital employees. The survey found that 63% of searches for physicians in the last year were for hospital employment; up from 56% in the previous year and only 11% eight years ago. At this pace within the next two years 75% of newly hired doctors will be hospital employees.
Mosley says employment seems to be a more popular option with younger physicians. "You see a lot of women gravitating towards hospital-based or site-specific jobs because it's set hours. They can work within their family schedule," Mosley says. "We also see a lot more women becoming hospitalists."