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Physician Hospital Employment Increasing at Rapid Rate

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How rapidly is physician hospital employment growing? As John Commins reports for HealthLeaders Media, pretty rapidly. According to a recent survey from a nationally renowned recruiting firm, “The shift toward the employed physician model has grown from a stream to a deluge, accounting for more than 90 percent of new physician job openings at hospitals, medical groups, health centers, and other healthcare facilities.”

Basing its findings on 3,158 physician and advanced-practitioner recruiting searches over an 11-month period, the firm found that “more than nine in 10 featured practices in which newly recruited physicians would be employed. Less than 10 percent of the recruiting assignments featured independent practice settings, such as partnerships, concierge practices, or solo practice settings, down from over 45 percent in 2004.”

Population health and value-based care are driving this “deluge” of hospital employment, as hospitals seek to increase their market share and leverage with payers, Commins writes. This despite the desire by physicians to retain autonomy.

According to one of the surveyors, “This is not a survey where I may catch someone on the wrong day and this is what they want to do or what they are threatening to do. This is what they did in the past year.

“It clearly shows that if you're a newly hired physician or provider, whether you've been practicing for 30 years or you are just out of residency, you have a nine-in-10 chance of taking an employed job. I am hard pressed to see that we are forcing people into that model. You wouldn't see such drastic numbers if that is not what both sides wanted.”

Family physicians and general internists continue to dominate recruitment efforts, especially since primary-care physicians now have “enhanced roles as team care leaders for accountable-care organizations and other value-based delivery networks.” With this demand comes an increase in their salaries, although specialists still (and probably always will) make more.

A notable nuance in these findings, Commins reports, “is the rise in concierge practice,” where recruitment efforts are up, even though recruiter services aren’t as readily required for concierge physicians, which could mean the shift in that direction is stronger than the findings indicate.

Also, while many physicians appreciate the push for value-based care, they’re struggling to implement it. According to the report, “the move toward value-based physician incentives stalled in the past year. In 2013, 39 percent of…search assignments offered a production bonus featuring at least one value-based metric such as high patient satisfaction scores or low hospital readmission rates… In 2014, that number dropped to 24 percent.”

According to the surveyor, “They love the idea of going to a value- and outcomes-based compensation model, but we are all struggling with how to accomplish it. We saw a spike last year and everyone said, ‘Oh gosh! This is where we are going!’ This year we saw a bunch of health systems say ‘let's wait until we have a clearer picture of the ACA.’”

And don’t blame the physicians for this, he added: “People think they are just greedy physicians who want to be paid. Not the case. Most physicians will tell you this is the right direction for healthcare. They just want a fair formula in place, especially when you look at team-based care and integrated networks, where you have all of these different mechanisms and value components that they are supposed to be judged and paid on. There are some things that we don't know how to adjust yet. And that is what the numbers reflect.”

As physicians looking for jobs, are you among your colleagues in seeking hospital employment? What are your reasons for doing this? Are you concerned as much as you once were with retaining autonomy? Have you considered becoming a concierge physician?

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