The evolution of healthcare in the U.S. has spurred many changes for medical professionals. The trend of increased physician employment, a change in the physician-hospital relationship, the decline of the private practice and lower physician career satisfaction all impact the nature and productivity of today's physician workforce.
Physician turnover in 2012 hit 6.8 percent, the highest since the American Medical Group Association began collecting data in 2005. Small groups suffer from 20.8 percent turnover among physicians during their second and third years, and 54 percent of physicians leave their group within the first five years. In addition to the financial costs of high physician turnover, there are also intangible costs to the community, including effects on patient satisfaction, impact on the continuity of quality improvement initiatives and effects on other providers and referral patterns.
In an Oct. 29 webinar hosted by Becker's Hospital Review and sponsored by Select International, Sam Agnew, MD, president of Global Trauma Solutions, and Michael Rose, MD, a member of the McLeod Health Board of Trustees and vice president of surgical services of the Florence, S.C.-based health system, discussed new approaches to addressing these issues from both the hospital and physician point of view. Bryan Warren, manager of healthcare solutions at Select International moderated the discussion.
According to Dr. Agnew, there is still a place for traditional, independent physician practices in today's healthcare environment. However, the changing nature of the industry demands physicians to engage with practices in new ways in order to make their organizations successful.
"If you're going to be a private practitioner, the expectation is that you can't just be a ghost and operate quietly within the system. You have to be a positive, contributing member of some sort of team or operation," Dr. Agnew said.
Dr. Rose shared a similar perspective, saying, "I think there is a strong legacy of private practices in this market, and I think they succeed because their reputations are excellent. There is a continued place for the independent practices with physicians who can maintain this impeccable professional reputation and offer patients responsiveness in their services."
Driving physician satisfaction
In regard to physician satisfaction, a principal issue for physicians today, Dr. Rose suggests satisfaction is more secure when a physician and practice are compatible in terms of goals and expectations.
"It is definitely still possible for physicians to find a stable, satisfying practice setting as an employee. When the practice's overall delivery is good, it includes benefits for the physician and the organization. Most of the synergy that comes from the relationship is when there is personal satisfaction for the physicians and alignment with the practice or organization's enterprise. The physician must look critically at the value system of the organization they are contemplating joining and determine if they fit," Dr. Rose said.
When the objectives of the organization overlap with those of the potential new physician, then there can be a rewarding relationship. If they don't overlap, the relationship could be a struggle, he explained.
The new climate of the healthcare industry — in both private practices and hospital settings — requires physicians to adopt more leadership in their roles, Dr. Rose and Dr. Agnew agreed.
New skillsets
According to Dr. Rose, the skillset required of physicians today has to broaden beyond merely being the clinical expert and scientist in the room. Physicians need to be more in tune with how the patient is experiencing care, and furthermore, physicians should contemplate how they value that care compared to alternative methods.
"Physicians and organizations have to be adaptable and nimble," Dr. Agnew said. "They can't be rigid in their beliefs. A 'my way or the highway' approach won't work. We as physicians have to be accepting of both objective and subjective criticism."
By creating honest and transparent metrics for criticism and determining a need for improvement, and encouraging physicians to be accepting of these metrics when they are reported, organizations can develop systems that accommodate a need for change without physicians' negative responses or egos getting in the way, Dr. Agnew suggested.
While it is important for all physicians to embody leadership qualities, both Dr. Agnew and Dr. Rose agreed that it is important for organizations to realize that not all physicians are created equally, and not all would make great leaders.
"All leaders need to be created over time, not just airdropped into your organization," Dr. Agnew said. I like to see leaders groomed from within rather than expecting someone from outside the organization coming in to be enormously popular culturally, assimilate and do all of these things over night."
Like a football team, great systems of leadership have coaches, assistant coaches and more assistant coaches. "There should be a series of leaders and support systems in which everyone plays to their strengths. It will be difficult for one physician to lead the herd," said Dr. Anew.
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