The impact that the COVID-19 pandemic has had on doctors is profound. Reports of anxiety, burnout, and depression, which began to surface within the first few months of the pandemic, have only grown more frequent as the pandemic has lingered. In mid-2020, a survey conducted by The Physicians Foundation found that 8 percent, or approximately 16,000 physicians, already had closed their practices as a result of COVID-19.
For the doctors who remain in practice, one result of the increased stress placed upon the medical profession by the pandemic has been an acceleration in the rate in which doctors are shifting from being independent physicians in private practices to employed physicians at hospitals or employed physician practices.
While the trend toward the employed physician model is not surprising, some results of the arrangement, and what “being employed” entails, seem to be catching both physicians and their employers off guard. The result has been a host of problems causing a loss of engagement and regret of the employment status, all of which could be avoided with the proper application of available technology.
The challenges of private practice
The top benefit of having a private practice is the high degree of autonomy that it offers to the doctor. Policies are set by the doctor and, provided regulations are abided by, can be as flexible as the doctor decides that they need to be. When decisions need to be made, whether they involve medical or managerial issues, the doctor can feel free to make them as he or she sees fit.
The top challenge cited by physicians in the private practice model involves the business side of operating a practice. A 2020 survey found the top factor contributing to burn out to be “too many bureaucratic tasks.” In the employed physician model, the top benefit is having bureaucratic and administrative responsibilities managed by staff members, leaving the physician available to focus fully on patient care.
The challenges related to managing a private practice have already resulted in the employment model being the preferred choice for younger doctors. However, the increased pressures brought on by the COVID pandemic has pushed even mid-practice and older physicians to reconsider private practice. According to a recent report, nearly seven in 10 physicians are now employed.
Where the employment model falls short
As doctors transition from private practice to being employed, their level of job satisfaction has a lot to do with the extent to which their managers support and mentor them. However, the manager–physician relationship has grown increasingly complex, demanding that new tools be employed to stay engaged and provide proactive and productive feedback.
The ability to manage the employee relationship requires the physician supervisor to collect data from multiple sources like human resources, the medical staff office, payers, legal, and revenue cycle. Historically each of these sources of data was either on paper, in an electronic file cabinet, or potentially in a siloed electronic solution.
Because each department maintained its own solution and data, leaders who managed the employment relationship with the physician rarely, if ever, understood the complete performance picture. Problems were frequently identified through internal audits or external agencies that levied fines and penalties. While the documents were at least retrievable, ongoing human intervention was required to generate a performance scorecard. Despite data being housed in all of the departments and functions described above, when inconsistencies occurred, physicians were asked to correct, update, or validate the data.
For many physicians, it is not unusual to keep professional documents in a box under the bed or in the trunk of a car, on a flash drive, or in a drop box or file cabinet. Graduation diplomas, Drug Enforcement Agency licenses, state licenses, previous training, previous case logs, and more typically reside in these various storage areas and the physician is responsible for keeping the information current and consistent. The problem with this model is easy to see. And it is easy to fix. Today, the technology exists to house all provider lifecycle data in one place.
How better management can save us from a healthcare crisis
That lack of attention and technology being applied to this issue may be contributing to a crisis: The aging population in the US will require more physicians at a time when one-third of all active doctors are preparing to retire or exit the profession and the rate of new medical graduates is stagnating. In fact, it is anticipated that by 2033, the US will face a deficit of approximately 133,000 physicians.
It is significant that many physicians who have enjoyed being, and have thrived as, independents are reconsidering their futures now and seeking employed positions. In the short term, they will join thousands of others who have landed in the employed model due to widespread consolidations and mergers, some COVID-19 related. What the healthcare industry cannot afford now is to lose any single physician to burnout or other factors, at the precise time when we need them the most.
As a result, we need to proactively provide physician managers the ability to give consistent, routine, and unbiased feedback on all aspects of performance. The time has come to integrate the data silos. The technology exists to do so, and the time to make the change is growing short.
– Dr. Mark Kestner serves as the Chief Innovation Officer for MediGuru and is the Strategic Clinical Advisor for ProCredEx. Since 1990, Dr. Kestner has had leadership roles in the military, university systems, integrated delivery systems as well as extensive experience in community-based healthcare systems.