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What Happens to Residents When the Physician Employment Bubble Pops?


The mega-shift toward more physicians becoming employees is creating the potential for a major problem down the road. If medical schools are training residents to be employees, how will they manage if they have to go into private practice?

Some are saying the employed physician bubble is about to pop. We've seen this movie before when hospitals bought practices and then had to divest them because the docs were not as productive as expected. Doctors get hired to generate an expected rate of return, just like every other investment. When the downstream lab and imaging revenues are not up to snuff, or their RVU productivity drops, then there is trouble in River City and the white coats start to get the pink slips.

Up to now, debt laden, lifestyle, work-life balancing residents have been more than accommodating to work for The Man.

So, if the trend has plateaued, what does that mean for graduating residents?

1. They are inadequately trained in the business of medicine and will have to be brought up to speed.

2. They will have to settle for lower salaries until they can prove their productivity warrants a higher one.

3. They will be inadequately trained in digital health and will have to be "rehabilitated."

4. They will have to figure out a way to pay off all those loans in the face of more competition and demands for productivity.

5. They will have to compromise when it comes to all those nice notions of work-life balance.

6. They will have to adopt a more entrepreneurial mindset.

7. They will have to adapt to the trade-offs of working for a physician-led organization versus a non-physician-led organization.

8. They will have to adapt to working in a smaller organization with a different culture than a larger organization with a corporate culture.

9. They will be held more accountable for costs.

10. It remains to be see whether all this lowers the suicide and burnout rate.

Unlike days of yore, private practice today is not the same as private practice of 20 or 30 years ago. Technology and different rules have enabled private practitioners to compete with the best of the large, integrated networks. They are nimbler, can change directions faster, and are quickly adapting. In the meantime, sadly, medical schools and residency training programs, suffering from craniorectal inversion syndrome, refuse to teach the Business of Medicine and are turning residents lose without a net.

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