Blog do Curso de Medicina da Universidade Estadual de Maringá para a discussão de temas de Educação Médica, Educação das Profissões da Saúde e áreas correlatas.
Blog of University of Maringá Medical School for the discussion of issues of Medical Education, Health Professions Education and related areas.
quarta-feira, 24 de dezembro de 2014
The Rise of the Employed Physician
Independent and group practice was once assumed as a certainty, now the
economics and politics of health care make that path much less likely.
the youngest member of a family of doctors, it was not uncommon during
my childhood to spend summers at my father's private practice. I fondly
remember greeting the familiar office staff as I recklessly ran amok
among an endless array of rickety cabinets containing an untold amount
of aging, yellowed paper charts. My dad's patients would tousle my hair
like family and his partners would always leave an insurmountable supply
of candy for my taking.
Years later, I found myself accompanying
my father and his practice partners for lunch as they discussed the ebb
and flow of running a medical practice. Beyond sharing complicated
medical cases, conversation often revolved around the complex
relationships with local medical practices and the independently-owned
hospital that my father and his partners had been affiliated with for
the past several decades.
By the time I entered medical school, I
developed the fixed assumption that, like my father (and grandfather and
great-grandfather), I would ultimately be co-running a small office
practice, develop a large but manageable patient panel and become highly
involved with a local hospital.
Now, I am not so sure.
the same time health care reform became a central theme to major media
outlets, enormous changes quickly presented themselves to my father's
workplace. The community hospital to which he was politically and
financially bound was rebranded into a multi-institution hospital
network. That same corporate system soon bought out his practice and
ultimately became his employer. This all occurred in the matter of a few
I asked my dad why he didn't resist these marked changes to his career. His response didn't surprise me.
daunting tasks of billing for multiple insurance networks and keeping
up with proper medical coding for hundreds of diseases were becoming
unbearably time-consuming and costly. Transitioning to electronic
medical records and staying current on meaningful use and quality
measures without managerial support was an increasing daily burden.
Dictation companies were eating up his bottom line and documentation was
eating up his time spent with his patients. He was tired of having to
keep up with the business and politics of medicine, but he wasn't ready
to let go of his practice of medicine.
And so, at 62, my father started his first employed job since finishing his medical training.
one's practice to work as an employee, as my father has done, or being
hired directly out of medical training, as I am likely to do, is not
unique to this era of health care.
Physician-owned practices in
2012 accounted for about 50 percent of all working doctors in comparison
to about 75 percent in the late 1980s. The number of physician-owned
practices continues to precipitously decline, as the percentage of
physicians who were practice owners in 2012 dropped almost 10 percent
from the previous five years, according to the AMA 2012 Physician Practice Benchmark Survey. This movement away from physician ownership is expected to continue.
political and economic incentives are certainly influencing these
trends. The public national agenda for rapid care integration and
coordination and the private agenda for reducing competition and
increasing leverage through consolidation are likely to accelerate the
move away from self-employment, particularly for emerging physicians.
How does the shift away from self-employment affect the new wave of practicing physicians?
can only speculate that newly-trained doctors must learn to be more
comfortable with managerial oversight from both physician and
non-physician executives. Skill-sets such as effective team building,
employment contract negotiation and the ability to "manage up" are
likely more relevant now than in prior generations, where self-employed
Importantly, in an era where patients see
an ever-increasing number of non-physician providers, it is likely that
young doctors will require a much more conscious effort to maintain a
sense of personal responsibility for the health and well-being of the
patients they care for.
I truly believe
that this era of health care is providing better care for our patients
than ever before, and I couldn't be more satisfied in having the
opportunity to take part in it.
Yet it remains to be seen how the
trend from the "physician-employer" to "employed physician" will impact
my generation of newly licensed physicians.