BIG MEDICINE, i.e. increasingly consolidated, expanded, and, in some instances, vertically integrated, sick care delivery systems are getting bigger.
BIG MEDICINE , i.e. increasingly consolidated, expanded, and, in some instances, vertically integrated, sick care delivery systems are getting bigger. Yet, over half of medical practices in the US are run by small medicine, independent medical physician entrepreneurs controlling professional services businesses.
The trend for the past several years has been that more and more graduating residents are electing to be employed physicians because of debt, the desire for a steady paycheck and benefits, work-life balance, and to get away from the perception that they won't have to deal with the business and administrative hassles of running a private practice. Some private practitioners have also thrown in the towel and sold out to BIG MEDICINE.
However, as health systems grow, they will have a harder time finding and keeping star performers.
Why? Because they will have a hard time addressing the reasons why their high level performers quit:
1. Stagnation: Let's face it. Practicing the art of medicine is always a challenge, but seeing 20 patients a day for 40 years starts to get tiring, particularly when doctors feel the only thing that matters is the number of RVUs you can post.
2. Overwork and burnout: It is no secret that physician burnout has become commonplace and almost an expectation of those not only in practice, but in an increasing number of trainees as well. "Just suck it up" is no longer acceptable as a solution for doctors and their families.
3. Fuzzy vision: The leaders of successful organizations lead innovators; they don’t manage innovation. That requires a clear vision of what innovation looks like and how you know it when you see it. For most organizations, that vision is blurred and fuzzy or only readable if you are nearsighted and myopic.
4. Profits over patients: Too often, leadership pays lip service to the mission while everyone knows what matters are profits.
5. Lack of recognition: Medical professionals have been academically successful their entire lives. However, that does not make them immune from a basic human need to be appreciated every now and then. Most get ignored if they do what they are supposed to do and earn what they are supposed to earn. Annual performance reviews are stupid, and, often, counterproductive.
6. Lack of trust: The bonds of trust are difficult to earn and can disappear in a day. Once that happens, it is almost impossible to rebuild them. Cynicism sets in and the new people have to clean up the mess.
7. Bureaucracy: Rules, regulations, mandates and compliance requirements are smothering doctors. As organizations get bigger and bigger, so do the rules.
8. Lack of ethics and professionalism: There are too many examples of physician executives; sick care leaders and administrators doing the wrong things.
9. They hate their boss: Interestingly, even if employees are self-employed
10. No longer a good fit, what they are good at, passionate about or happy to do: Ok. They moved your cheese. The world changes every day. The disaffected will lead, innovate and act like intrapreneurs if given the chance, follow if they are underperformers, leaving you with the worst of the worst or move on.
Employee engagement comes with a dark side, so BIG MEDICINE should be careful what they ask from their employed doctors.
For these reasons and more, the employed physician bubble will pop, the net migration of doctors to and from employed situations will equilibrate, and many will be left holding the sick care bag. In many instances, in the bag will be a pink slip.