To begin, this article on Career Trends will touch on many concepts and trends going on in the physician arena right now. We will look at career trends nationally and touch on various concepts without going to deep in the interest of time. If you require data supporting various concepts or would like more specialty specific information, please contact us at any time.
In general, some of the trends are listed as follows:
- New physicians are seeking employment more than traditional practice settings. Most opportunities now will give the option of both employed and guaranteed opportunities.
- Physicians are more clinically than business oriented. Hospitals tend to be stronger at the business of medicine and rely on physicians for the clinical side. This always causes the physician and hospital relationship to be somewhat strained but each opportunity is unique and hospitals support physicians in a number of different ways. You should always ask the hospital how they will support you when practicing in their area.
- Call Coverage is the major deterrent of solo practice with the business and challenges of running your own business also changing physician behavior. Very few solo practices will exist in the next 10 years.
- Indebtedness continues to be a minor factor in specialty/practice decisions. Physicians are used to coming out with fairly significant debt and building a practice also means a significant startup cost. These challenges are overcome with compensation and sign-on bonuses to attract physicians.
- Modest interest or even awareness of Rural Assistance loan repayment programs exists. Most physicians would rather repay over time in the right opportunity at the right location than move to something they don’t want.
- Recent surveys show that the important factors in a desirable practice are now Time for Family and personal, adequate support staff and services, Long Term Income Potential and Flexible Scheduling. We see that Lifestyle is the number one factor whereas before the compensation and practice specifics were all physicians looked for.
- Previously, physicians came out of training, established a practice somewhere and never moved because they built that patient base and when they moved, they would have to start over again. Now we have a shortage of physicians that allow physicians to move and build up a practice much easier. Generally it is accepted that 6-9% of physicians move every year and it is much more normal for a physician to have three or four jobs before settling into one for the rest of their career.
- Physician shortage facts are that in 2010 there will be an estimated 50,000 shortage and in 2020 there will be an estimated 200,000 shortage. The proportion of female physicians is rising and younger physicians are limiting their work hours for a work-life balance. Baby Boomers are now aging and requiring more physician services and currently 1/3 of all physicians are over the age of 55. Physician retirements will grow rapidly over the next 20 years. The proportion of Third year Internal Medicine Residents choosing to practice primary care fell to 20% in 2005 from 54% in 1998. General Surgery is also experiencing difficulty attracting the candidates to choose that specialty because of the Lifestyle difficulties.
- Job Board Explosion has caused thousands of opportunities to be listed with little information or knowledge of that particular situation and caused the physician to spend enormous amounts of time researching and talking to recruiters finding out the real story.
- Malpractice still has a few states in crisis and specialties like Obstetrics, Neurosurgery, General Surgery, Vascular Surgery, and Cardio Thoracic Surgery are still very high. Practices or Hospitals have had to pick up the costs associated with these and more specialties.
- Tail Coverage can be an issue with the cost of the tail picked up by the new employer but that may require a candidate to stay for 3-5 years to pay it back.
- Stipends allow facilities to lock in candidates when they are residents or fellows. A time repayment clause will apply here as well.
- The incubator model of compensation is where a physician will be employed by the hospital for a year and then after the first year the group can hire a physician as an employee or partner at that time. This is done so the hospital can assist with recruitment fees and follow Stark III regulations and the group can still issue a noncompeting clause in their contract.
- For opportunities with a net or gross income guarantee, there is usually a 90 day out clause with payback responsible for the initiating party. Payback is required by law and forgiven with an industry average 2-3 years.
- Employment is a growing trend and this is the only way for the hospital or group to insure exclusivity. Employment with a partnership track is averaging only 1 year rather than the 2-3 years previously.
These and many more trends will be addressed. Look for an update to the above article soon and please feel free to contact us with your questions.