Physicians

The Stunning Shift Toward Employed Physicians

By DAVID E. WILLIAMS

I’m amazed at just how quickly physician employment has swung from small independent practices to hospital-based employment. I’ve heard about it anecdotally from medical societies and malpractice carriers who are seeing their constituents shift, and have certainly observed the shift from individual physicians, but I’m still surprised how fast it’s occurring. A new report from recruiter Merritt Hawkins tells the clearest story I’ve seen:

  • In the last 12 months, 56% of physician search assignments have been for hospital jobs, whereas 5 years ago it was just 23%
  • Just 2% of assignments were for independent, solo practice docs compared with 17% 5 years ago

Doctors are becoming more like regular wage earners, albeit high paid ones. There are some strong drivers of this trend including the need to support health information technology, comply with regulations and deal with health plans. There’s also a desire on the part of a younger, increasingly female physician workforce to have a better balance between work and home life. If anything the forces pulling physicians into hospital employment will strengthen in the near term with the arrival of Accountable Care Organizations and other forms of deep integration.

Yet when a pendulum swings it tends to swing too far. Especially considering how quickly things have moved, I do expect that there will be some backlash to the rush into employment. It’s really not all that much fun having a boss, especially when that boss is a big, bureaucratic hospital with other things on its priority list besides MD satisfaction and career development. Patients may not like it so much either. I know I’d rather see a physician who’s not too tightly tied to a hospital.

So what will the reversal look like? I don’t think it’s going to be doctors rushing to put up their own shingles or buy practices of retiring docs like in the old days. Instead I expect to see a new breed of physician employers who recognize what’s needed to make docs happy, treat patients well, manage compliance, and still make money. One example is so-called direct primary care practices such as Qliance. Time will tell what other forms develop.

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Halloween sexy costumeskredyt bez zaswiadczenStuart Ditchek.MDmichael southworth,MDPamela Wible MD Recent comment authors
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Halloween sexy costumes
Guest

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kredyt bez zaswiadczen
Guest

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Stuart Ditchek.MD
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Stuart Ditchek.MD

As a physician in practice for over 25 years, the trend is alarming. Physicians who join hospital systems will be very disappointed in their salaries as Medicare and Medicad payments to these institutions reduce in the coming years. Hospitals are businesses like any other, the difference being that the vast majority of their payments are based on Medicare rates. As the federal government continues to allow Medicare to become insolvent, Medicare rates will be cut dramatically over time. As the rate cuts occur, these newly salaried “employee physicians” will see lower paychecks. It will take five years, but we can… Read more »

michael southworth,MD
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michael southworth,MD

I totally agree the shift is dramatic. Having after 20 years in private practice just finished my first two years as an employed physician I can tell you the only comforts have been the continued support of patients and a steady paycheck. The rest of it is a wash. Under layers of administrative voodo unsafe or nonproductive activities that one could see changed quickly in private practice now are no longer changeable. I have seen my principles regularly compromised. Buyer beware.

John Ballard
Guest
Pamela Wible MD
Guest

The ultimate physician employer is the patient. Physicians who collaborate with their communities and patients will be designing the clinics of the future.

Inspiring models: http://www.youtube.com/watch?v=4YJz5wvt2bk
and http://www.youtube.com/watch?v=dtEFIFqhw6I

Pamela Wible, MD
3575 Donald St. #220 
Eugene, OR 97405
(541) 345-2437
http://www.idealmedicalcare.org

“(S)He is the best physician who is the most ingenious inspirer of hope.”
~ Samuel Coleridge

John Ballard
Guest

Hmm…
Sock puppet?

MD as HELL
Guest
MD as HELL

Tort reform is not the answer. We need tort elimination. Malpractice awards need to be removed from the court and handled like worker’s comp. The huge awards have never ever been justified. DeterminedMD, I glaze over when I try to read Ms. Mayer. In general I agree with everything you say. This post started about employee docs. Fact is medicine has become too complicated to do both. It did not used to be that way. Not every town had medical care. Private practice was the only model. Fee or no fee for service. Docs adopted a town or a population.… Read more »

John Ballard
Guest

@MD as HELL
What a screen name!
I hope your bedside manner is not as harsh as your curmudgeonly public persona. If all I had to go on was your comments I would never want you for my PCP.

DeterminedMD
Guest
DeterminedMD

Yes, you would be pleased with the status quo that is to be Obamination care, automation health care without dissent or individual attention, just cookie cutter bs that focuses on money, and oh, who gets to pocket the alleged savings that will be made, as there always will be a profit margin in health care, even though politicians won’t admit to that. MD as Hell is right on the money, “..no one has to care anymore.” Enjoy your provider who quotes standards of care that do not care who or what your issues are. PPACA. The new abbreviation for “hear… Read more »

Peter
Guest
Peter

Given tort reform in many(most?) states why are we even discussing medical malpractice? It appears that this system is self regulating since you need a major injury for the lawyer to even consider your case. “It would be difficult to simply make a list of the types of malpractice cases that are good or bad. Each case is unique and needs to be considered on its own particular merits and facts. But there are certain issues your lawyer will have to work through before deciding if he can accept your case. Since malpractice cases are so expensive and time consuming… Read more »

Dr. Mike
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Dr. Mike

@ John Ballard
If it were up to me to design a system for medical malpractice claims, I would have each county set up a board (to include physicians and lawyers) that would evaluate each claim prior to it proceeding. They would determine if the patient suffered harm, and if that harm could have been reasonably prevented. Valid cases would then go to arbitration. Invalid cases, or those that failed arbitration could go to a loser-pays-all-costs trial.

John Ballard
Guest

@Dr. Mike Fascinating approach, albeit a political stretch to enact. (I have a hard time imagining what interest groups might support or oppose such a construct.) Pushing arbitration to the community (county) level would make it tough to abuse since all parties would presumably be obliged to live together with the results. School boards, grand juries and local draft boards are already precedents for such a system If adopted locally via referendum (I’m thinking smoking bans, liquor laws, land use codes, etx.) with state and/or federal waivers it might even be constitutional. The more I think about it, the better… Read more »

maggiemahar
Guest

Peter

Peter– Yes, and so well-put!

Maggie Mahar
Guest

Dr. Mike & Tim– I understand what you are saying. Physician fear of a lawsuit is quite separate from the odds that any individual doctor will be sued. The emotional cost of a lawsuit is incalculable. As Justice Brandeis said: there are two things to fear in life: death and litigation. This why I belive that we need to move away from an adversarial approach to malpractice to a “full disclosure” approach. Yes, we need better laws in many states to protect the “disclose, apologize and offer an early settlment” strategy, but in places where this has been done well… Read more »

Nate Ogden
Guest
Nate Ogden

Maggie have you ever held a real job at any time in your life? The stuff you say is so far detached from reality I’m honestly curious what sort of life experience you have had to develope these. “But it would be much less costly for payors (insurers, hospitals) to settle quickly than to pay the very high administrative costs associated with suits that usually go on for years.” Um, no it isn’t. The reason we figth these claims is becuase it is cheaper then paying them. I would think that is common sense. Do you really think these tens… Read more »

Margalit Gur-Arie
Guest

Anybody here has knowledge of, or cares to comment on, the Kaiser mandatory arbitration model?

Maggie Mahar
Guest

Nate– You’re mistaken. First, this is what a “closed claim” is: (As you can see, it can be a case that was settled, or a case that went to court.) “Professional Liability Insurance Report of Closed Claim ——————————————————————————– Instructions A claim is any demand for damages (whether or not for a specified amount, and whether or not a lawsuit has been filed) for personal injuries alleged to have been caused by error, omission or negligence in the performance of professional services, communicated orally or in writing to the reporting insurer or risk management organization. Pursuant to G.L. chapter 112 section… Read more »

Nate Ogden
Guest
Nate Ogden

I’ll check it tonight

Tim
Guest
Tim

Talking about the results of jury awards and the reasons for defensive medicine are two different topics. Doctors don’t study Harvard research about what juries did and did not get right; they practice so as to avoid the next lawsuit. I have intimate knowledge of many malpractice suits over many years. I can tell you that: Juries do indeed like doctors and are not easily duped. But this is irrelevant. Lawyers do not bring suits expecting to go to a jury. They play the settlement lottery. They do not spend millions of dollars on malpractice cases; they can spend very… Read more »

BobbyG
Guest

“They play the settlement lottery.”
___

Two words: Loser Pays.