I work with physicians on the job market, looking for the opportunity that will help them achieve their practice goals, and with hospitals and private practices that are looking for an outstanding provider who will be a good match for the opportunity and serve the community well for years to come. Without going into the politics of healthcare reform and philosophical differences in how to improve access to care, here are some thoughts on the physician job market will adjust.
- Independent, private practices will be largely unsustainable in the regulatory environment of Accountable Care and will become a thing of the past. But on the plus side, hospital ownership of a practice eliminates many of the headaches of private practice. Billing is done at the corporate level, staffing is often linked to a “float pool” of workers who can fill in if the front desk person is sick suddenly, a better line of communication with the hospital services and records, etc.
- Primary Care becomes a hot commodity. Guarantee salary situations and other improved compensation features will follow. It’s the law of Supply and Demand.
- Joining Patient-Centered Medical Homes (PCMH) and Accountable Care Organizations (ACOs) will mean working in a more collaborative, better staffed practice, as particular standards of care and levels of staffing are dictated.
- Medicaid expansion–those states that implement it–will require cutbacks somewhere to pay for the additional enrollees. Prepare for across-the-board reimbursement cuts over time in those states that expand coverage.
- Any administrator who has implemented a large-scale EMR project (as we did with Epic in 2003 at NorthShore University HealthSystem) knows that large-scale change tips the scale towards attrition for a small number of physicians on the cusp of retirement. Nearly every community in the county (except New York City) already needs physicians, but additional (perhaps inevitable) loss of practicing physicians creates greater demand and broader varieties of practice opportunities and settings to choose from.