[Noah930]

More recently over the past few decades there are more multiple-physician practicees. These are still private practices--just with more than one doctor in the group. This has happened due to a variety of reasons: the business and logistical headaches of running a solo practice business, certain efficiencies of scale by having multiple doctors under one roof, potential marketing advantages by having multiple providers, more relaxed call schedule, etc. Either way, the essential billing and collecting practices continue: fee-for-service and/or participating in insurance plans. The doctors are still the partners/bosses running their business. How a doc earns an income within the group model will vary. Some groups will still have "eat what you kill" economics, minus a communal and equal contribution to the office overhead. Other groups may have some sort of profit-sharing or division of collections, such as where an individual may take home x% of their collections but then contribute the remaining percentage of collections to a pot that gets divided equally amongst the docs. Again, though, this is still a practice run and owned by the docs involved.

That's different than the even more recent trend of being hired by a large group or hospital. In this situation, the doctors are W-2 employees. This seems to be happening more frequently. Partly because of the economics of private practice, the hassles with running a business, the hassles of increasingly relying upon large insurers (whether private insurance companies or federal ones like Medicare/Medicaid), etc. Partly due to the increasing importance of private time (family time) desired by physicians. Effectively doctors give up a bit of their autonomy in exchange for being able to just punch a clock, so to speak. In this case, the doctor is a hospital employee. He/she draws a salary from the hospital. And in return, the hospital has a little more say in what the doctor has to do. You work when they tell you to work. You cover the shifts/times/holidays they want you to cover. You do the procedures/treat the patients they tell you to treat. Well, maybe not as indentured servitude as that, but certainly a vast difference from making all those decisions for yourself. I think if you talk to most doctors, this is the trend. This is the way more and more doctors will be practicing in the future.