When the calendar turns to July, the new month may create excitement and anxiety for individuals: July 4th celebrations; hot weather; vacation plans; and yes, the calendar year is halfway done. For physicians, July may also mean the official start of a professional career when a residency and/or a fellowship is complete or the anniversary of an employment start date. The hopes and expectations of the “new” physician this July may be different from the more “seasoned” physician. It is important for each of the “new” and “seasoned” physicians to understand and appreciate their respective perspectives to create the best opportunity for professional harmony.
Below are some issues that “new” physicians and “seasoned” physicians who are the employers should keep in mind to ensure the best chance of prolonged success.
Burnout. Very few physicians consciously accept a job where they don’t want to be. A much higher number of physicians actually “burn out”. A recent story in HealthCareDive (www.healthcaredive.com) reported that as many as two-thirds of U.S. physicians reported feeling burned out or depressed (or both). The same article noted that physician burnout is estimated to cost hospitals and health systems as much as $1.7 billion annually. The costs from burnout-related turnover for all U.S. physicians is approximately $17 billion annually according to the HealthCareDive article.
The conundrum for all physicians is the HealthCareDive story suggests that fewer bureaucratic tasks and fewer hours spent working may help alleviate burnout. Yet, demands to see more patients or produce more wRVUs or handle more administrative tasks often impede on a physician’s “personal” time. Clear communication and realistic expectations by both the employed physician and the employer may help ensure a longer and more productive professional relationship.
Payor changes. Across the country, payor models of reimbursement continue to evolve. The models in place from five years ago may now be dramatically different in that same community. More risk-sharing. Pay-for-performance. Increased use of quality measurement tools. Expansion of Medicare and/or Medicaid managed care programs. As these payor changes occur, this may have a direct and indirect impact on the means by which a physician practices medicine which may, in turn, affect a physician’s compensation. It is important to encourage a physician to continue to be an excellent clinician and at the same time become a better businessperson who understands the challenges and opportunities resulting from changes in payor programs as this will likely lead to better communication and hopefully a more productive physician.
Technology changes. As a general rule, physicians who are more junior are more apt to use and embrace newer technologies than their more senior counterparts. The “gaming” generation may “demand” these clinical and diagnostic tools because this is what they used during training and it may be the only way they know how to practice medicine. This phenomenon is not unique to medicine. More senior lawyers can regale their junior colleagues with the time they spent in their office’s library with stacks of books researching prior judicial opinions or statutory history looking for that critical piece of the analysis to shape their written product. More junior lawyers have likely never cracked open a hard copy chapter of a state’s statute and rely on the click of a mouse to access all information. Employers should embrace newer technologies where clinically advantageous and not economically prohibitive and more junior physicians should be prepared to articulate the benefits of purchasing the new technology and the positive changes it will bring to the employer and to the patients they serve.
Gender changes. The Doximity 2018 Physician Compensation Report notes that in 2017, “for the first time, more women than men enrolled in U.S. medical schools.” Statistically, the same Doximity study reported that female physicians were paid less than male physicians in 2017, approximately 28% less. The Doximity study noted that in 2016 female physicians did not out-earn male counterparts in any of the top 50 metro areas. A female and male physician working the same hours with same duties should be compensated the same. A female physician should be an advocate for herself to be compensated appropriately and a more seasoned physician – male or female – should compensate a “newer” physician fairly and competitively.
Industry changes. Consolidations and new affiliations continue to occur at a rapid pace. Hospitals merging with one another. Hospitals acquiring physician practices. Private equity groups acquiring medical practices and physician groups merging. Cross-industry consolidations: payors becoming providers and providers becoming payors. For a young physician and even a more seasoned physician the rumors and the actual changes can seem confounding and counter-intuitive. Health care changes have created interesting “bed fellows” and new alliances and competitive threats continue to emerge. Change happens and physicians need to be prepared to embrace the changes and be able to react and respond in a timely manner.
The health care world is changing and physicians (newer and more seasoned) are not immune or insulated from these changes. One of the more “famous” doctors, Dr. Seuss, aptly described the world the newer physicians are now entering in the classic story, Oh The Places You’ll Go: “You have brains in your head. You have feet in your shoes. You can steer yourself any direction you choose. You're on your own. And you know what you know. And YOU are the one who'll decide where to go…”
Just like Dr. Seuss, understanding that nothing is forever and changes will occur (many times out of the physician’s direct control) will best prepare the newer physician to be a good businessperson (and always be a great clinician) and remind the more seasoned physician that new ideas and new energy can be contagious so that both sets of physicians will realize: “Just never forget to be dexterous and deft. And never mix up your right foot with your left. And will you succeed? Yes! You will, indeed! (98 and 3/4 percent guaranteed.)”