Stone CourseADVISORY LLC
RESOURCES
Employment, compensation and reimbursement evidence can frame a question. It cannot answer a particular physician’s ownership decision.
RESOURCES · ECONOMICS. AUTONOMY. CHOICE.
Employment can provide stability and infrastructure. It can also create friction around autonomy, productivity expectations and compensation. The question is not whether ownership is always better. It is which model works for you.
EMPLOYMENT LANDSCAPE · JANUARY 2026
Hospital/corporate affiliation in PAI/Avalere’s defined physician database, not all licensed U.S. physicians. PAI/Avalere employment report.
An IQVIA OneKey extract covering practices with Medicare-billing physicians; not a measure of dissatisfaction.
EMPLOYED-PHYSICIAN EXPERIENCE · 2026
In a survey of 1,003 employed physicians, 44% were looking for or considering another job; 47% frequently felt pressure to prioritize patient volume over optimal care. PAI/Healthsperien survey.
Job consideration does not mean rejecting employment or planning independent practice.
RVU-SHAPED COMPENSATION · 2024
In Medscape’s survey of 1,005 physicians, 70% said RVUs measured productivity poorly; 80% were dissatisfied or very dissatisfied with RVUs shaping salary and bonuses, as reported by Becker’s Hospital Review.
Self-reported survey findings, not a national census or peer-reviewed causal study.
REAL MEDICARE PAYMENT · 2001–2025
AMA estimates a 33% decline in inflation-adjusted Medicare physician payment from 2001 through 2025. AMA payment analysis.
2026 brought higher conversion factors; this is not a claim that every code or commercial contract pays less. 2026 final-rule summary.
Different populations, not one market-size calculation. PAI/Avalere classifies physician affiliation through an IQVIA OneKey extract; the AMA’s weighted 2024 survey of 5,000 eligible patient-care physicians separately found 57.5% employees, 35.4% owners and 7.1% independent contractors. Do not average these measures or multiply them by job-search or burnout percentages. AMA methodology and comparison.
The 2026 employment survey. PAI/Healthsperien surveyed 1,003 employed physicians online April 14–May 4, 2026. Physicians spending less than half their professional time in patient-facing work, and those in physician-majority-owned practices, faculty groups or medical schools, were screened out. The 44% and 47% describe these respondents, not all U.S. physicians; 89% were satisfied with the care they personally provided. Full 2026 survey and methodology (PDF).
The RVU survey. Medscape surveyed 1,005 physicians March 1–May 26, 2024. The published news summary reports attitudes toward RVU-linked pay and productivity, not the effects of becoming independent; question-level subgroup denominators are not separately specified in that summary. Survey reporting and limitations.
Payment scope. The 33% is an AMA inflation-adjusted Medicare physician-payment estimate, not every payer, facility fee or CPT code. The 2026 Medicare conversion factors increased to $33.57 for qualifying APM participants and $33.40 for nonqualifying practitioners; a separate negative 2.5% work-RVU efficiency adjustment generally applies to non-time-based services, with exceptions. The increase does not mean each service’s payment increased. AMA historical estimate; AAMC final-rule explanation.
Sources reviewed September 30, 2026. These studies and reports do not establish a national count of dissatisfied physicians, causation or readiness for independent practice. No source organization endorses Stone Course.
A work relative value unit (wRVU) represents the work component of a service. Medicare payment also includes practice-expense and malpractice RVUs, each geographically adjusted, before applying a dollar conversion factor. An employer’s contractual dollars-per-wRVU rate is a separate compensation term, not Medicare’s conversion factor. CMS Physician Fee Schedule explanation.
We separate production credit, contractual compensation and actual collections in the financial model. More wRVUs do not, by themselves, establish more take-home income or a viable independent practice.
WHAT WE HELP YOU TEST
Depending on your agreed scope, we examine the economics, control rights and execution requirements of employment, independence or partnership. Counsel reviews legal contract terms.
Test which model is economically viable for your practice before making an irreversible move.
Discuss your modelSPECIALTY ECONOMICS · LOOK BEYOND THE HEADLINE
Expand a specialty for one research finding and the question it raises. These are selected historical Medicare code sets, not forecasts of your contract, income or return.
A study of 22 glaucoma procedure codes found an average 20.5% inflation-adjusted Medicare reimbursement decline from 2000–2020; one code increased. This is a selected-code result, not all ophthalmology revenue. AAO summary of Journal of Glaucoma research, 2022.
Decision question: What do your actual procedure mix, payer contracts, staffing and facility arrangements produce after costs?
A Medicare fee analysis of selected high-grossing codes found average inflation-adjusted annual declines of 3.63% for interventional procedures versus 0.87% for evaluation/management services, 2014–2023. These are annual averages, not total-period declines. Pain Physician, 2024: public study abstract.
Decision question: How sensitive is your model to the mix of procedures, office visits, authorization workload and payment lag?
Across 20 selected urologic-oncology codes, mean inflation-adjusted Medicare physician reimbursement declined 41.08% from 2002–2024. The study does not represent every urology service or payer. Urology Practice, 2025: public abstract.
Decision question: Which site-of-service, procedure and payer assumptions actually determine your contribution margin?
An analysis of ten common GI procedures found an average 33% inflation-adjusted Medicare reimbursement decline from 2007–2022, as reported in a summary of American Journal of Gastroenterology research. Office/inpatient visit trends differed. Read the study reporting.
Decision question: What do your endoscopy access, anesthesia arrangements, payer mix and operating costs imply for the practice model?
A study of 48 laryngology procedures found weighted inflation-adjusted annual reimbursement declines ranging from 0.9% to 2.2% across analyzed setting/procedure groups, 2000–2021. The study concerns laryngology, not every ENT procedure. The Laryngoscope, 2024: public abstract.
Decision question: How do your office/procedure mix, site of service and actual contract rates change the economics?
A published 2024 study abstract reported a 48.0% mean inflation-adjusted Medicare reimbursement decline from 2000–2024 for 30 foot-and-ankle codes selected using one academic center’s activity. Treat it as a selected-code abstract, not a comprehensive specialty estimate. Foot & Ankle Orthopaedics study abstract.
Decision question: Are the proposed procedure mix, ancillary access and capital requirements supported by your own data?
A 2025 review describes declining gynecologic-surgery reimbursement, limitations in RVU assignments and persistent undervaluation of female-specific procedures. It does not provide one universal decline percentage for OB/GYN. Current Opinion in Obstetrics & Gynecology: public review abstract.
Decision question: Do compensation, service mix and payer rates reflect the work and overhead of your proposed model? GYN-focused practices are considered selectively; full obstetrics still requires separate coverage, hospital-access, malpractice/tail and emergency-pathway review.
A 2025 Cutis review discusses historical Medicare payment erosion for commonly performed dermatologic procedures. The finding is not evidence that every code or region declined, or that dermatologists are dissatisfied with employment. Cutis review and underlying references (PDF).
Decision question: What do your specific medical, surgical and Mohs mix and payer contracts support after staffing and overhead?
A retrospective Medicare analysis found a 22.5% decline in inflation-adjusted weighted mean reimbursement across its selected surgical-specialty codes from 2011–2021. Code selection and weighting matter; it is not a universal fee cut. Public study abstract, 2024.
Decision question: Which actual fee-schedule and expense assumptions would change your model-choice decision?
Burnout, job-search intent and dissatisfaction with an employment model are different measures. In a study of 1,437 family physicians, ownership was no longer associated with burnout after adjusting for practice environment; this is observational evidence, not proof that either ownership model is best. Annals of Family Medicine, 2019.
For supporting professional guidance: American College of Surgeons: Burnout in Surgery; American College of Gastroenterology: Physician & Provider Wellness; American College of Obstetricians and Gynecologists: Why Ob-Gyns Are Burning Out. These older educational resources are not current prevalence surveys or endorsements of Stone Course.
We provide business and operational decision support, not mental-health care. A sound recommendation may be to stay employed, renegotiate, change employers, delay or pursue ownership.
A DEFINED NEXT STEP
A conversation to clarify fit, scope and the evidence needed next.