Healthcare Occupational Shortages – Part Three
More and more physicians are becoming direct employees of hospitals or having their practices purchased by hospitals and health care systems. Physicians have become, at the least, indirect employees. Academic medical centers have a long history of physician employment, with house staff, consultants, and attendings having some sort of employment relationship. However, this has not been true for most community-based hospitals and health systems over the last 50 years.
When reviewing the health care literature, several factors stand out:
1. More and more hospitals see physician employment as a guarantee to patient access, and therefore revenue and marketshare.
2. More and more physicians are struggling to maintain revenue in private practices and see employment as a potential solution.
3. The transition for physicians from private practice to employment is not easy or often positive. (Strategic Programs Inc.’s Physician Engagement Study data results 2010-2014).
4. Assimilating physicians into hospital staffs with HR Policies, work rules and productivity standards has been difficult and has produced turnover, management problems and created unexpected challenges.
5. Just as hospitals are growing dependent on fully employed, quality-focused, engaged and productive physicians; the number of available physicians to fill these needs is declining.
The trend in care practice focus is moving from acute, inpatient care to ambulatory care in a variety of formats. Primary care physicians, such as internists, pediatricians, and family practice physicians, will provide most of that care. The literature suggests that population growth through 2015, the additional people with insurance seeking care, and the retirement of aging “Baby Boomer” physicians will require an increase of over 50,000 primary care physicians to meet increased demands. Shortages in specialty positions such as general surgeons and a geographic mal-distribution of many other specialties are also looming.
The keys for hospital and health system employers, and particularly Human Resources professionals, will be to recruit sufficient numbers of physicians, get and keep them engaged, and encourage productivity and quality without offending their sense of clinical autonomy, as well as be prepared for the day when those efforts will not be sufficient to meet needs.
Keep in mind Physicians accepting employment are giving up the two “Sacred Cows” of private practice – Clinical Autonomy and Financial Independence. Hospitals make value-based purchasing decisions for equipment and surgical instruments, have restrictive formularies that might not include every physician’s favorite antibiotics or the latest rheumatology drugs, assign shifts or work hours to physicians, as well as have metrics around productivity that physicians may not understand or that they believe interferes with their clinical judgment. In addition, physician reimbursement is not directly related to the volume of work, procedures they accomplish, or outcomes they produce. Our physician satisfaction survey and consulting work indicates as a consequence that employed physician morale is lower than needed to produce the necessary levels of engagement.
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