In 2000, nearly 60% of physicians were practicing independently. Compare that to two years from now, when it’s predicted that just 33% will continue to practice solely outside of a larger health system. According to a report from Accenture, the global consulting company that released those figures, between now and 2013, the rate at which independent doctors are being employed by larger systems will increase by 5% per year.
You probably don’t need numbers to tell you that practice models are changing dramatically. New and evolving paradigms of healthcare provision have already led to some large-scale shifts—hospitals buying up private practices, for example.
The incentive for such large scale practice consolidation is clear from the hospital perspective, as it allows them to capture referrals and keep lucrative procedures (e.g. endoscopies, elective surgeries) in-house. But what is driving so many physicians to abandon the private practice model?
Hospital-based employment offers stability in an uncertain economy, particularly for young doctors entering the job market with considerable educational debt. According to the Association of American Medical Colleges, new physicians are leaving medical school with an average debt burden of $158,000.
In addition, work-life balance is becoming increasingly important for newer generations of doctors. Hospitals offer better call coverage and more predictable schedules. Moreover, they allow doctors to offload countless administrative responsibilities, such as billing and staffing, while simultaneously providing access to state-of-the-art IT tools and equipment. All of this helps physicians eliminate much of the noise in their daily workflow, allowing them to focus on patient care.
The consequences of the changing landscape of clinical practice has been the subject of a great deal of discussion. There is one outcome, however, that hasn’t gotten much coverage. The way in which physicians think about and develop their careers is undergoing a fundamental shift.
Specifically, the business of being a doctor is becoming less dependent upon the horizontal connections between specialists and referral sources, and more dependent upon vertical relationships within an organizational heirarchy. Resumes are replacing business plans, and time once spent on marketing and cost-management is now being devoted to the pursuit of career-building opportunities, like taking on leadership and administrative roles, conducting internal research or developing QI initiatives.
As this trend continues, the growth challenge for doctors will be more about career management and less about business development, a change that may favor residents and young attendings, who are more accustomed to the competitive landscape of academic medicine. Competition for chief resident spots, publication opportunities and stage time at grand rounds and specialty conferences may prove to be the ideal training for a new generation of career-oriented physicians.
Alex Blau is medical director of Doximity.
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