Employment Trend

[Sneezing]

I predict in the future as a result of "quality" measures being pushed by medicare and ultimately hospital administrators grappling for those few extra dollars there will be a shift in employment.

This blog piece http://www.1docsopinion.com/2011/04/04/customer-satisfaction-does-not-equal-quality-healthcare/ exemplifies the transitioning role of physician to customer service at the whims of patient demands.

As a resident I'm already fed up with hospitals and this emerging attitude that I want nothing to do with them and I want nothing to do with medicare or CMS. I predict this trend will spread and there will eventually be a transition away from the consolidation we've seen by hospitals/large groups/health systems. Physicians will again pursue solo or very small group practices that don't take CMS funds, and are less enslaved by their "quality" measures.

---

Members don't see this ad.

 

[Radonkulous]

...

 

[bronx43]

I hope so. I had no intent to work for someone else when I went into medicine and I still won't when I finish my training.

On a similar note, my personal feeling is that we may be seeing the end of medicine being the most "secure, independent" profession we have known. We are training too many people every given year given the current supply i.e. pathology, radiology, etc. New entrants are exceeding the ones exiting the field. This in turn weakens any leverage doctors might have had 10-20 years ago since we are becoming a dime a dozen. Our services might soon become a commodity (i.e. teleradiology, hospitalist, etc.), but I hope I'm wrong. If this is not the case, it is still partially true. You won't be able to live where you want to if you want to practice medicine. The boonies might be one's best option to hold onto the aforementioned ideals that once defined the profession.

For all intents and purposes, many specialties' services are already commodities, regardless of their supply. When you don't have significant face time and direct rapport with the patient population, then your services are largely fungible, which ultimately places you at the mercy of the supply and demand within the market. Hospitals have every intention of reducing their overhead, and if they are able to hire other physicians on the cheap, they will, until it's race to the bottom.

 

[BLKPA2MD]

I predict in the future as a result of "quality" measures being pushed by medicare and ultimately hospital administrators grappling for those few extra dollars there will be a shift in employment.

http://www.nejm.org/doi/full/10.1056/NEJMp1101959

http://well.blogs.nytimes.com/2011/04/14/what-big-medicine-means-for-doctors-and-patients/

 

[Radonkulous]

...

 

[bronx43]

It begs the question, which specialties are immune to this takeover?

I don't know about absolute immunity, but the more face time you have and the more rapport you can build with your patient base, the safer you are from being a fungible commodity. That's why I'm relatively bullish on primary care, as it's a field where you're not only the first in line to medical care, but you have the most direct influence on patients medically and personally. And obviously, fields like pathology and radiology, where you have little to no patient contact, will only fare as well as their supply allows them. And when the health care market contracts in the midst of a crumbling American economy and financial system, the intrinsic value of being a PCP will be painfully obvious. The specialties offering high-end and elective care with low cost-effectiveness will be wiped out first. The high-end, relatively cost-effective services will still have a market, albeit a smaller one.

 

[oldiebutgoodie]

I don't know about absolute immunity, but the more face time you have and the more rapport you can build with your patient base, the safer you are from being a fungible commodity. That's why I'm relatively bullish on primary care, as it's a field where you're not only the first in line to medical care, but you have the most direct influence on patients medically and personally. And obviously, fields like pathology and radiology, where you have little to no patient contact, will only fare as well as their supply allows them. And when the health care market contracts in the midst of a crumbling American economy and financial system, the intrinsic value of being a PCP will be painfully obvious. The specialties offering high-end and elective care with low cost-effectiveness will be wiped out first. The high-end, relatively cost-effective services will still have a market, albeit a smaller one.

I think the problem is in "building rapport". Rapport often depends on the amount of time spent with the patient, but it's not financially feasible to spend a lot of time with your patient, right? (esp if Medicare). I hear this a lot: "I go to the PA" or "I go to the NP" "because they spend more time with me". Not saying this is right or wrong, it's just the facts. Hopefully Medicare and insurance companies will begin to respect the value of the primary care physician, and pay you for your time.

Oldiebutgoodie

 

[bronx43]

I think the problem is in "building rapport". Rapport often depends on the amount of time spent with the patient, but it's not financially feasible to spend a lot of time with your patient, right? (esp if Medicare). I hear this a lot: "I go to the PA" or "I go to the NP" "because they spend more time with me". Not saying this is right or wrong, it's just the facts. Hopefully Medicare and insurance companies will begin to respect the value of the primary care physician, and pay you for your time.

Oldiebutgoodie

That's the price you pay for adding the value of rapport building. If you want to make more money in the current reimbursement system, then go ahead and run your practice like a sweatshop and have limited face time with your patient base. But, it places you at greater risk for being replaced, since you or any other provider are basically exchangeable in the eyes of patients.
I've been looking for a free lunch since I was born, but I still haven't found one.

 

[Slack3r]

http://www.nytimes.com/2011/04/23/health/23doctor.html?pagewanted=1&_r=1

 

[Slack3r]

http://www.nejm.org/doi/full/10.1056/NEJMp1101959

http://well.blogs.nytimes.com/2011/04/14/what-big-medicine-means-for-doctors-and-patients/

The article cites Kaiser as an innovative health system somewhat in the vein of Mayo or the CC. I was under the impression the Kaiser system kinda sucked?

 

[Radonkulous]

...

 

[DoctwoB]

The article cites Kaiser as an innovative health system somewhat in the vein of Mayo or the CC. I was under the impression the Kaiser system kinda sucked?

A lot of people in California swear by Kaiser. And say what you will about it, but kaiser is a major reason why per capita medicare costs are much lower in CA then they are in other parts of the country, despite higher labor and land costs. Everyone, including the university hospitals, have to compete with the cost pressure put on by Kaiser.

And there's no shortage of docs willing to take a higher starting salary (at the expense of future earning potential) in a very large call pool with great benefits/vacation. Its a trade of independence for job security/risk, and a lot of docs are making that trade.

 

[Caped Avenger]

I predict in the future as a result of "quality" measures being pushed by medicare and ultimately hospital administrators grappling for those few extra dollars there will be a shift in employment.

This blog piece http://www.1docsopinion.com/2011/04/04/customer-satisfaction-does-not-equal-quality-healthcare/ exemplifies the transitioning role of physician to customer service at the whims of patient demands.

As a resident I'm already fed up with hospitals and this emerging attitude that I want nothing to do with them and I want nothing to do with medicare or CMS. I predict this trend will spread and there will eventually be a transition away from the consolidation we've seen by hospitals/large groups/health systems. Physicians will again pursue solo or very small group practices that don't take CMS funds, and are less enslaved by their "quality" measures.

yeah, i agree. i wonder how long it will take for it to be turned around or if at all...