The physician workforce is evolving faster than at any point in modern medical history. While compensation has risen modestly in recent years—with average gains between 3% and 5% in 2024—almost half of U.S. physicians still report that they do not feel fairly compensated for the workload required to earn those increases. More importantly, pay is no longer the primary factor driving career decisions. Physicians are grappling with high burnout, shrinking autonomy, administrative overload, and overwhelming pressure that extends far beyond the exam room.

“The pay keeps inching up, but the workload grows twice as fast.”

These challenges are set against a sobering backdrop: the United States is projected to face a shortage of 13,500 to 86,000 physicians by 2036. Despite this urgent need, more physicians than ever are searching for ways to remain in medicine without sacrificing their well-being. Many no longer want to leave the profession—they simply want to practice in a way that doesn’t consume their lives.

This is where fractional doctoring enters the conversation.

Fractional practice models offer physicians the ability to use their expertise while gaining more flexibility, autonomy, and control over their schedules. What began as a niche practice option has now become a rapidly growing movement, especially among mid-career physicians who want manageable workloads and early-career physicians who value balance as much as compensation.

This article explores why fractional work is gaining momentum, how physician compensation trends are fueling the shift, and why both physicians and healthcare systems are embracing this modern, sustainable practice model.

Why More Physicians Are Questioning Full-Time Practice

A rising number of physicians are stepping away from traditional full-time roles. Nearly 40% report that they plan to leave their current organization within the next two years [1]. This trend reflects a larger reevaluation of what it means to practice medicine in today’s healthcare system.

Burnout and Emotional Fatigue Remain High

Burnout continues to affect more than half of all physicians. In 2025, 54% reported symptoms of burnout—numbers that have hardly budged despite ongoing efforts to address the issue [2]. Women are disproportionately affected, experiencing burnout at significantly higher rates than men [3]. Certain specialties, including emergency medicine, internal medicine, and critical care, continue to carry some of the highest emotional and mental burdens [3].

“It’s not the medicine that exhausts me—it’s everything wrapped around it.”

Burnout is no longer a temporary phase; for many, it has become a defining feature of their careers.

Administrative Overload Is Consuming Physician Time

One of the most consistent sources of frustration among physicians is administrative burden. Doctors now spend nearly two hours in the EHR for every hour of direct patient care [1]. Family physicians report spending 4.5 hours during clinic on electronic tasks and another 1.4 hours at home [4]. Nearly a quarter log more than eight hours a week in after-hours documentation alone [5].

This burden has changed the nature of work itself. What used to feel like a relationship-built profession now feels increasingly like nonstop data entry.

Declining Autonomy Has Become a Breaking Point

Perhaps the most significant shift in the medical profession is the dramatic decline in physician autonomy. Only 44% of physicians owned their practice in 2022—down from 76% in the 1980s [6]. Employed physicians increasingly report limited control over scheduling, referral decisions, and clinical workflows. Many describe feeling more like corporate employees than independent clinicians.

“I used to decide what was best for my patients. Now I need approval for basic decisions.”

Loss of control is strongly associated with higher burnout and greater intent to leave clinical practice [7]. As autonomy declines, the appeal of alternative practice models grows.

What Fractional Doctoring Actually Is (and Isn’t)

Fractional doctoring is a flexible practice model in which physicians work a defined portion of full-time hours—typically with one or two organizations—while maintaining consistent responsibilities and long-term relationships. It offers the continuity of traditional practice with the flexibility physicians increasingly crave.

Unlike locum tenens, fractional roles are not temporary, travel heavy, or unpredictable. They also differ from traditional part-time roles, which often come with reduced benefits, fewer opportunities, and cultural stigma within medicine [10]. Fractional positions are designed around predictable, ongoing commitments that serve both the physician and the organization.

This model has gained tremendous traction among younger physicians, who view variety, autonomy, and work-life balance as essential components of a satisfying medical career [11][12]. It has also become a lifeline for mid-career clinicians looking to reduce their hours without stepping away from clinical practice.

What Fractional Doctoring Looks Like

Fractional practice takes many forms depending on specialty, community needs, and physician preferences. Examples include:

• Covering a rural hospital’s inpatient service 7–10 days a month

• Providing specialist call coverage one or two weekends monthly

• Rotating through satellite clinics once or twice a week

• Combining in-person clinical work with telemedicine or virtual visits

• Supporting quality initiatives, advisory roles, or leadership on a fractional basis

These models give physicians flexibility while enabling healthcare organizations to maintain reliable coverage without the cost of hiring full-time specialists. Unlike short-term locums assignments, fractional roles allow physicians to build seamless relationships with staff and patients.

How Fractional Practice Differs From Part-Time or Locums

Fractional practice differs from traditional part-time roles and locum tenens in several ways. Part-time work is typically a scaled-down version of a full-time job, often with reduced benefits and limited opportunities for advancement [10]. Locum tenens roles, while valuable for certain career stages, are temporary and require frequent site changes, onboarding, and travel.

Fractional practice, by contrast, is designed for long-term consistency. Physicians may maintain clinical continuity while enjoying schedules that support their well-being. Organizations benefit by securing stable coverage tailored to their needs.

This balance of stability and flexibility has made fractional doctoring a respected and increasingly mainstream career choice.

How Compensation Trends Are Fueling the Shift to Fractional Work

Even as compensation rises, many physicians feel the financial rewards no longer match the demands placed upon them. Average physician income climbed from $363,000 in 2023 to about $374,000 in 2024 [2], with primary care seeing a 5.7% increase and specialists around 4.0% [13]. Yet only 48% feel fairly compensated [2], and nearly 70% say their earnings stayed flat or grew minimally despite rising workloads [14].

The pay gap between specialties persists. Primary care physicians earn about $287,000, while specialists average $404,000 [2]. Emergency physicians earn around $330,000 including bonuses [15], yet still experience some of the highest burnout rates in medicine [16].

Financial incentives are shifting as well. Signing bonuses grew to $38,215 in 2024–2025, while relocation and CME stipends average $12,619 and $4,073 respectively [17]. Quality-based bonuses—once a key part of compensation—have dropped from 64% of contracts to just 16% [18], signaling a broader shift away from rigid performance metrics.

“More money doesn’t fix burnout. Better control over my time does.”

Fractional roles address precisely that need: more control, more balance, and a more sustainable pace.

Why Physicians and Healthcare Organizations Are Embracing Fractional Practice

Fractional practice benefits both sides of the healthcare equation. For physicians, it offers flexibility, autonomy, and improved well-being. Physicians working fractional or reduced schedules report higher satisfaction, lower burnout, and greater control over their time [19]. Many describe feeling reconnected to the purpose that originally drew them to medicine.

For healthcare organizations, fractional practice addresses long-standing staffing challenges. Many hospitals—especially rural and community facilities—struggle to recruit full-time specialists. Fractional roles allow them to secure coverage without the cost and commitment of hiring full FTEs. Turnover costs can exceed $500,000 per physician [23], making fractional options financially attractive as well.

Only 59% of physicians say their workplace supports schedule flexibility [22], yet research shows that physicians with flexible schedules are more engaged, 26% more productive, and generate significantly more revenue [23]. Fractional practice becomes not just a staffing solution but a strategy for retention and improved performance.

Real-world examples highlight the model’s impact. Oncology groups successfully use 10-day block scheduling to maintain consistent coverage. Surgeons working fractionally spend more time performing procedures and less time on administrative work. Specialists rotating through satellite clinics report greater satisfaction and continuity of care [19][21].

A hospital CMO shared, “Fractional staffing kept our service lines open when full-time recruiting wasn’t working.”

Across diverse settings, fractional practice is proving that flexibility and high-quality care can coexist.

Conclusion: Fractional Practice Is Becoming the Future—Not a Fringe Option

Physicians today face unprecedented pressure, and the traditional full-time model no longer meets the needs of the modern workforce. Fractional doctoring offers a sustainable alternative—one that allows physicians to remain clinically active while regaining autonomy, balance, and control.

Healthcare organizations benefit equally from this shift, gaining reliable specialty coverage, reducing turnover, and strengthening recruitment in a competitive market. As more physicians consider or adopt fractional roles, the model is quickly transitioning from a niche option to a mainstream strategy.

“Fractional practice gave me a way to stay in medicine—without losing myself in the process.”

Fractional doctoring is not simply a trend—it is a viable, sustainable, physician-centered path forward in a healthcare system that urgently needs new solutions. It gives clinicians a way to continue practicing the profession they love while living a life that feels balanced, purposeful, and whole.

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