“I want to explore employment opportunities with you.”

He is looking at me. Trying his hardest. Passion, yet anger, in his eyes.

Everything I know about him and his tenure in the community helps me understand how difficult this conversation is. Everything I see in his eyes helps me understand how painful this is.

Private practice is dying, on the vine, in America.

The practices fold or reach a critical point, and they come running to big med to fix all the problems.

Absorb. Acquire. Integrate. Consolidate.

Every week I get a call.

“Will you buy my charts? Why not? I have been a longstanding provider in this community!”

“Will you buy my practice? Why not? I have been loyal to the system?”

Fact is. We are all struggling to stay afloat. I live in the guts of big med and let me tell you … we are doing the best to survive. We are trudging the influx of government regulation, population health contracts, outcomes data, patient experience pressures, reimbursement changes, meaningful use, union negotiations, massive expansion of Medicaid and quality control.

Physicians write about “raging against the machine” or finding the “Katniss” of healthcare.

But the reality is that we cannot all go out and be independent. That may work for some primary care innovation, but how does it work for subspecialty care in which providers are dependent upon a large referral network or a large amount of hospital inpatient care? How does that work for bundled payments and government payers? How does that work for the millennial physician workforce that is flocking to employment?

In some ways, they just got us by the balls.

So, I take a different approach. Rather than fight the machine, I dive deep inside the confines and internal mechanics. I place my stamp of influence in the core function of the beast. If physicians are unhappy about the way our big med corp is run, they should get involved and be part of the solution. Take a seat at the table. Get involved. Otherwise, stop complaining about what big med is “doing” to you.

While I know we were trained to be clinicians and care providers, the rapidly changing and evolving healthcare environment requires more of us. The train has left the station. More and more physicians are enrolling in leadership programs and earning advanced degrees in business administration and medical management. The age-old days of a token MD in the C-suite are a thing of the past. Physicians are also taking a seat at the helm of big med.

***

“Being employed is different from an independent model. While there are some benefits, the loss of autonomy can be a challenging and difficult adjustment …”

I spell it out to him. No sugar coating. No false promises. No unrealistic expectations.

He loves his patients. He loves his community. This is his life. He is willing to try and make it work. I’m nervous of his ability to adjust, but value his commitment to his patients and community. We agree to give it a try.

I make no excuses about the experience of being an employed physician or provider. It is very different from private practice. It’s not for everyone. But, as a leader in big med with a large constituency of providers in my department, I do value their employed experience. I want them to be happy. I want to set realistic expectations of what we can and cannot do. I want to be fair. I want them to have work-life balance. I want them to be paid fairly. I want to listen. I want them to want to take good care of our patients.

But, I recognize that we will continue to make difficult decisions as time goes on. Decisions that will affect some people negatively. Decisions that will push providers to change behaviors. We will no longer be able to build a care program around providers, rather we will need to build care programs around our patients and our systems. Physicians should not only have a voice in this process of change, but they should be intricately involved in creating the solutions.

Note: All medical leadership stories are fictionalized.

Eve Shvidler is an obstetrician-gynecologist and author of Burning the Short White Coat: A Story of Becoming a Woman Doctor.  She blogs at burning the short white coat.

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