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Friday, January 4, 2013

Employment Incentives for Physicians



Physicians now share many of the ‘employment’ concerns as others. As more MDs become employees of health systems they forfeit their own self-initiative and freedom to change their personal course, hours, and ability to perform for their patient’s best interest without concern for their employer’s mindset.

It is often a difficult walk.

According to CEB’s Quarterly Global Labor Market research Most employees when surveyed about jobs are searching  for the top five things employees look for when seeking a new job are:

  1. Stability
  2. Compensation
  3. Respect
  4. Health Benefits
  5. Work-Life Balance


In today’s rapidly changing and evolving health organizations, the lone wolves and/or even small groups are at the mercy of larger health systems, and insurers who look for wide coverage availability.  The larger organizations may actually not be more efficient or better but they offer stability just on the basis of inertia.

Compensation has consistently risen in group practices

Respect. The day of the exceptional solo physician and/or specialist who is sought out is gone.  In a former time, individual exceptionalism drove solo practice or small group practice.  Today where searching for a physician personal recommendations have diminished except in a group practice where the primary care doctors have a closed system of specialists they must refer to in their group.  The quality is totally dependent upon the standards set by the group practice. Most solo physicians were and are respected because of their individualism and insistence on the physician-patient relationship.  The relationship is derived by patient choice of physician in a free market (which is rapidly disappearing). Patients still recognize the benefit of seeing a physician who is a ‘free agent’ to make decisions to refer to the “best” regardless of insurance restrictions and distance.  This becomes critical when diseases are severe, and not common, necessitating a search for providers who have experience with a disease or particular procedure in greater numbers.

Health Benefits:  Even physicians are unable to access or choose affordable care. This applies to their staff as well as themselves personally.. The quicksand of health plan reorganization, and uncertainty of PPACA, and ACOs and rising premiums will not change with health reform.  Health care may be somewhat more accessible especially to the previously uninsurable, but it will not be less expensive, and the currently insured will be paying more, as well as higher taxes, a hidden insurance premium cost.

Work-Life Balance:  Perhaps this is the major factor driving Physicians to becoming employed.  The relief of ‘running a business’  removes much stress from financial and legal liability. Having an institution with administrators increases cost, however it should professionalize the ‘C’ Suites and yield better business.  In a smaller private practice backup is less assured, dependent upon loose organization and often enforced by a department or emergency room coverage agreements. Today with many MDs avoiding hospital privilege the available consultants has diminished. Group practices have a built in enforceable duty schedule, and it is doable. “When people talk about work life balance they’re not saying they don’t want to work as much,” he says, maybe by way of calming the nerves of exasperated employers. “They’re simply saying they want flexibility in the time that they do work. The word flexibility needs to be recognized as not about how much to work but when that work is getting done.”

Physicians have rarely been under-employed, however there are great disparities in specialties due to severe shortages in mental health, pediatrics, and certain niche specialties. Shortages are often addressed by using allied health providers, nurse practitioners, or physician assistants.

In the past most physicians desired were self-employed. The Bureau of Labor and Statistics reported that  in the past 24 months the balance has shifted. A number of jobs in professional and related occupations have relatively high (above 10 percent) incorporated self-employment rates. For instance, the rate was very high for dentists, architects, physicians, and lawyers.  A recent survey by the Medical Group Management Association shows a nearly 75 percent increase in the number of active doctors employed by hospitals since 2000, and recent hospital announcements suggest this trend is accelerating.

With the changing paradigm of health care, the Massachusetts Medical Society conducted an email survey to Massachusetts physicians in order to learn more about the current practice environment in Massachusetts as it relates to employed physicians or physicians considering moving to an employed position.  

The email survey was sent to physician members and non-members in October 2012. Of those who responded to the survey, 60% were employed, 38% were self employed and 2% were self employed but considering an employed position.

(to be continued)

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