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68% of New Doctors Prefer to be Employed Physicians

68% of New Doctors Prefer to be Employed Physicians | Healthcare and Technology news |

Newly-minted physicians have between fifty and one hundred job offers to sift through before the starch even wears out of their lab coats, according to a new survey by Merritt Hawkins, and the majority will choose employment with a larger practice, hospital, or health system over entering a solo private practice.  As an ongoing shortage of physicians, driven in part by the burden of mandates such as meaningful use and the expense of EHR adoption, begins to put the squeeze on care availability, new trends in physician employment are changing the way healthcare is delivered in the United States.

“Unlike virtually any other type of professional in today’s economy, newly trained doctors are being recruited like blue chip athletes,” said Mark Smith, president of Merritt Hawkins. “There are simply not enough physicians coming out of training to fill all the available openings.”

The organization asked more than 1200 medical residents about to graduate into the job market, about recruitment opportunities and their future plans.  More than 60 percent of the residents had received more than fifty solicitations from recruiters in the last year of residency, while 46 percent were flooded with more than one hundred job offers.

The overwhelming number of offers may have something to do with the extraordinarily low percentages of new recruits choosing what have become challenging career paths: solo practice or employment in a rural area.  Just two percent of respondents were interested in opening up their own practice, while a mere three percent would consider seeking a position in a community with less than 25,000 people.  More than two-thirds of new physicians headed straight for larger medical practices in more urban areas.

These decisions are contributing to the growing shortage of care in rural areas, which is compounded by an increasing number of elderly patients, more patients becoming eligible for care under the Affordable Care Act and Medicaid expansions, and the prevalence of chronic diseases.  In Colorado, for example, some rural counties would need to increase their physician population by more than 100% to meet basic state benchmarks for the ratio of providers to patients.

But that might not happen if the urban employment trend continues.  “The days of new doctors hanging out a shingle in an independent solo practice are over,” Smith said. “Most new doctors prefer to be employed and let a hospital or medical group handle the business end of medical practice.”

Yet even physicians who secure a place in a hospital or group setting are not entirely happy with their choice.  A quarter of residents indicated that if they had the option to start over again, they wouldn’t even choose the medical field at all.  Physician dissatisfaction is at an all-time high, driven by everything from an overwhelming number of EHR alerts that interrupt patient care and frustrate technology users to the coming of ICD-10, which is placing a considerable strain on hearts and wallets alike.

Employed physicians might not have to worry about cooking their own books, but they complain instead about being treated as cogs in a machine, losing autonomy, and being mismanaged by executive staff.  A March survey by the former American College of Physician Executives, now the American Association for Physician Leadership, found that many employed physicians gripe at corporate culture clashes, a lack of financial incentives, and disinterest in their opinions from organizational leaders.

“With declining reimbursement, increasing paperwork, and the uncertainty of health reform, many physicians are under duress today,” added Smith. “It is not surprising that many newly trained doctors are concerned about what awaits them.”

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Physician Employment Landscape Set to Change in 2015 |

Physician Employment Landscape Set to Change in 2015 | | Healthcare and Technology news |
The healthcare landscape will continue to consolidate through physician employment and new practice choices from medical students in 2015 and beyond.

Physician employment at larger healthcare organizations will increase rapidly in 2015 as consolidation of providers and financial pressures squeeze private practices into closing their doors.  Between the anticipated costs of ICD-10, changes to reimbursement structures that promote value-based payments, and a desire for more care coordination by working in extended teams, new medical students and established practitioners alike are leaning towards banding together in larger, more stable groups.

“The coming year will again be one of major transition for the U.S. healthcare system,” said Lou Goodman, PhD, president of The Physicians Foundation and chief executive officer of the Texas Medical Association.  “Regulatory and marketplace forces are having a number of unintended effects, including challenging the viability of smaller medical practices, reducing patient choice and putting tremendous strain on the physician-patient relationship.”

The Physicians Foundation envisions several key challenges for providers in the next year, including external pressures on the patient-provider relationship that make practicing medicine less satisfying.  Even though one recent study states that physicians are actually spending more time with each patient now than they did a decade ago, continued dissatisfaction with the intrusion of EHR documentation on the workflow and other regulatory pressures are driving unhappy physicians to retire, seek employment with fewer administrative burdens, or reduce their availability.

Physicians who seek employment at bigger health systems tend to report higher levels of job satisfaction and more time to focus on the patient relationship, the ACPE found earlier this year, but must also contend with the downsides of being a smaller piece of a more complicated system.  Employed physicians are more likely to report feeling unheard and unrecognized for their achievements.  Physicians at private practices that have been acquired by larger health systems feel poorly integrated and complain about a lack of cultural alignment that would incentive them to perform at their best.

Medical students and new physicians are pinning their hopes on the benefits of employment, however, says a separate report from EHR developer athenahealth.  The Epocrates Future Physicians of America survey found that ninety percent of medical students will not go into private practice, which is a fifty percent increase from 2008.  Students desire the financial security and work-life balance of employment in larger facilities, and want to avoid the difficulties of being a small business owner in addition to a full-time physician.  Part of this pattern is due to inadequate instruction during medical school on how to operate and manage an individualized practice, according to nearly 60% of respondents.

In addition to feeling poorly prepared for being self-employed, medical students recognize the importance of working in larger teams with better communication and more non-physician support.  Care coordination is top of mind for 96% of these newly minted MDs, and 75% believe that better coordination is dependent on EHR data sharing, interoperability, and health information exchange.

As physicians adjust the way they practice to take advantage of more modern expectations of being valued, balanced, and engaged in the workplace, their needs must be addressed in order to maintain high levels of patient care and sufficient access to healthcare for the millions of newly insured citizens under the Affordable Care Act, Goodman says.  “It is paramount that policy makers bring physicians into the fold to ensure the policies they implement are designed to advance the quality of care for America’s patients in 2015 and beyond.”

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