Tuesday, April 29, 2008
New Doctors - New Culture
I attended a hospital retreat this weekend and the subject was how do we recruit new physicians into a medical community when they don't want to do private practice medicine? New young doctors want controlled lifestyle, guaranteed salary, benefits and predictability. The type of practice most primary care doctors have is just the opposite. We have no salary guarantee...you eat what you kill (pardon the awful metaphor). Patients don't get sick during predictable hours and there have been many years when I funded my employees IRA but there was no money left over to fund my own. That is just business "crazy" and the young doctors are smart enough to know that.
Today's article in the Wall Street Journal , "As Doctors Get a Life - Strain Shows" addresses this very issue. U.S. medicine is undergoing a cultural revolution that will change how patients receive care. It has already begun, with the emergence of "hospitalists", doctors who only work in the hospital and take care of patients who are admitted. The days of the family doctor meeting you at the Emergency Department and taking care of you in the hospital are long over. The hospitalist works by shift and when he goes off, another one assumes responsibility for the patient's care.
Young physicians do not want to take call. When they are off they want to be off. If they do cover on weekends, they expect to have weekdays off to be with family and friends. Young physicians do not want to deal with office employees or running a business. They expect a full schedule of patients to be there and an office administrator to deal with other business aspects like contracting with insurers, collecting payments and worrying about Medicare hassles.
The problem is that primary care practice and even some specialty practices have not been set up this way. There are thousands of practices across the U.S. that have aging physicians that want to retire or turn their loyal patients over to a new emerging doctor. The new doctors are choosing dermatology and plastic surgery as career choices (really, how much botox does America really need??). The number of doctors that choose primary care or general surgery as a specialty has plummeted and those few absolutely do not want to take over the old style practice.
Medicine is going to have to adjust really quickly to forgo a major shortage of caregivers over the next few years. Hospitals across the country are having difficulty finding doctors to take Emergency Department call. To counter this trend, hospitals are developing employment models for the new physicians so they can provide salary and benefits and office management.
In California, there is a law that prohibits hospitals and other corporations from employing doctors. Medical groups in Universities, Kaiser-Permanente and community clinics are able to offer real jobs and the new physicians are going for it. But that leaves the aging private practice physician with even more work, more call and no way to transition their patients when they retire.
In the meantime, I have about 15 people a month asking me to recommend a physician because their doctor dropped all insurance or retired. I have no names to offer.
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