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Join Corinne Sundar Rao, an internal medicine physician, and Aaron Morgenstein, an orthopedic surgeon, to explore the evolving landscape of medical practice. We discuss the challenges health care facilities face in recruiting and retaining physicians, the shifting preferences of newer generations for part-time and alternative careers, and the innovative strategies that medical facilities can adopt to address these trends.

Corinne Sundar Rao is a board-certified internal medicine physician and founder, Legacy Physicians, which helps hospitals find well-qualified physicians at a much lower overhead than they would pay staffing agencies. She can be reached on LinkedIn and Facebook.

Aaron Morgenstein is an orthopedic surgeon.

She discusses the KevinMD article, “It’s time for the C-suite to contract directly with physicians for part-time work.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Aaron Morgenstein and Corinne Sundar Rao. Aaron is an orthopedic surgeon, and Corinne is an internal medicine physician, and together they wrote the KevinMD article “It’s time for the C-suite to contract directly with physicians for part-time work.” Aaron and Corinne, welcome back to the show.

Aaron Morgenstein: Hey, thank you so much.

Kevin Pho: So both of you have been on the show before. Go to KevinMD.com/podcast; in the upper right-hand corner, there’s a little search icon, and you can search for their names to hear their stories. But today I want to jump right into your article, “It’s time for the C-suite to contract directly with physicians for part-time work.” So, Aaron, how did this particular article come together?

Aaron Morgenstein: For those who know me, I have a passion for helping physicians find the opportunities that are best for them, and sometimes the hospitals or the health care system itself do not always present the best opportunities for these physicians. I got this great opportunity to go out to Charleston, South Carolina, and give a talk to the Carolinas Physician Services, the CAPS organization, which is an arm of the national physician recruiter organization. In preparing that talk and that PowerPoint, I actually had Corinne review it. The talk was well received, and afterward Corinne had the good idea to say, “Hey, we should turn this into an article and submit it to KevinMD.” And we did just that.

Kevin Pho: All right, so Aaron, tell me about the landscape when it comes to jobs not fitting what physicians may be looking for today.

Aaron Morgenstein: I think we have a trend of physicians, particularly younger physicians, looking for something different. Unfortunately, what I hear is that there are either employed jobs or nothing at all. I think we need to start looking at positions out there for physicians, especially the younger generation, that are part-time or less than full-time, and hopefully these new opportunities match the work-life balance physicians are looking for these days, and match the well-being of the physician and the health care services.

Kevin Pho: So Aaron, you’re an orthopedic surgeon, and Corinne, you’re an internal medicine physician. Corinne, tell us what you’re seeing in the world of internal medicine, in terms of what physicians may be looking for and what employers are commonly offering.

Corinne Sundar Rao: Kevin, what I’m seeing is that physicians are looking for something that’s not a completely full-time employed position, some variation of it. It seemed to be that there was only full-time employment or locums, and nothing in between. However, we know that’s not true, and Aaron and I have explored this quite a bit. There is flexibility to be found. My favorite term is PRN, or as-needed, positions, and you can actually put together a schedule you like with a few different facilities. Facilities, on the other hand, seem to be either somewhat resistant to the idea or just not current enough to know that this is what most of the physician workforce is looking for, and I think that’s what Aaron was speaking to.

Kevin Pho: And Corinne, what are some of the reasons newer physicians are looking more toward part-time work?

Corinne Sundar Rao: I think, for one thing, the newer generation is more about work-life balance, and more about the ability to have other interests they want to pursue. And then, Kevin, I think the burnout factor is always there. Part of the issue is that physicians are getting burned out sooner in their careers.

Kevin Pho: And Corinne, I just want to follow up on what you said earlier. The two real options traditionally would be full-time employment and locums. For those who aren’t familiar with the locums world, tell us a little more about the locums option.

Corinne Sundar Rao: Usually what happens is that there are many locums companies, nationally, locally and regionally, and they source jobs; there could be a couple of other middlemen involved. They post these jobs, and physicians who are looking go to one or more of these companies and say, “This is what I want.” They’re presented to facilities, and they look at positions that may be available temporarily to fill. That’s how that works. The locums company arranges your compensation and keeps its cut out of it. Usually travel, et cetera, is paid, and the locums company covers your malpractice. So that’s how that works.

Kevin Pho: All right, so Aaron, as more and more physicians look for part-time employment, how are employers feeling about that?

Aaron Morgenstein: I think you see a mixed bag of health care systems, administrators and C-suites opening up to this idea. To me, it’s a bit foolish for these health care systems to spend ungodly amounts of money on staffing agencies. Those can be locums companies, or some of these private management companies, some of them even backed by private equity. I’m at a loss for words as to why they wouldn’t want to hire someone on a part-time basis, especially if they’re struggling to recruit and retain physicians at their facilities. So I think there’s a lot to it.

Kevin Pho: So when you talk to these facilities and sense a little of that reluctance to contract with physicians directly for part-time work, what are the reasons behind it, if it makes so much sense?

Aaron Morgenstein: I think one is that these hospitals have relationships with those locums companies, or these private management companies, with contracts that are truly unfair to their health care systems and truly unfair to the physicians who are actually providing those services. The second thing is that I think health care systems don’t fully understand, or haven’t updated themselves on, the recent Stark law revisions. I believe, and I’m no lawyer, so speak to a lawyer or a legal representative to understand these Stark law revisions, that they state you can contract directly with physicians and pay them fairly, and you do not need a middleman to pay them fairly.

Kevin Pho: And Aaron, when we talk about part-time work, let’s make sure we’re on the same page. What exactly do you mean by that, from a physician standpoint?

Aaron Morgenstein: Like I said earlier, for me it’s either full-time or part-time, and part-time can be anything. It can be a physician who works one to two days a week. It can be someone who works one to two weeks a month. It could be someone who just does weekend coverage. It could be someone who says, “You know what? I’ve got to take my kids to school at 8:30, and I’ve got to pick them up at 3, so I can work from 9 a.m. to 3 p.m. every day.” So instead of a traditional work model of, let’s say, an eight-hour clinic, we shorten it to a six-hour clinic, so you can still spend time with your kids and your family.

Kevin Pho: All right, then let’s talk more about that solution. Corinne, in the scenario Aaron presented, about work-life balance, sometimes life gets in the way, and it’s not always congruent with a traditional employment model. So if I’m a physician listening to both of you right now, other than locums, tell me what some of my next steps should be.

Corinne Sundar Rao: Kevin, there are different ways to go about this. Use your network; that’s something we always say. Use your network to source opportunities around you, try to connect directly to the facilities and see where that gets you. And be persistent about it, because sometimes they may not have a need right then, but they might down the line, so you can connect with them that way as well. What’s important is that it’s really alluring, very enticing, to think of being the author of your own schedule. For me, I feel like I just can’t go back to a traditional model, because I enjoy being able to get time off when I want to and curate my own schedule. So it’s definitely doable, but it does take some work.

Aaron Morgenstein: Kevin, if I can add one other thing to that: As physicians, we go online, and we don’t need to name those third-party sources that list jobs, but the majority of jobs being posted are for full-time employment. Those are great opportunities to call those facilities and say, “Hey, I’m not interested in five days a week. Could we do four days a week?” I think there’s something to negotiating: “Hey, I want to work for you. I like the community you’re in, and I would like to be a part of it, but because of this or that, can we change the job description? Can we work two days a week? Can I work 10-hour shifts instead of eight hours? Can I do 10 days off?” Whatever it may be, there needs to be a negotiation. So physicians should not be afraid to call and speak with the facilities directly, understanding that many times the in-house physician recruiters cannot change the job description. So in some instances, you may want to ask to speak with the chief medical officer, or maybe the CEO. It really depends on the size of the facility or the size of the health care system.

Kevin Pho: So I’m going to ask each of you for a success story. Corinne, I’m going to ask you for one from the world of internal medicine, and Aaron, perhaps you can share a story from a surgical subspecialty, where this has actually worked in action. So Corinne, why don’t you go first? Tell us a success story where you’ve heard of a physician in internal medicine reaching out directly to an institution to create a schedule that’s really amenable to them.

Corinne Sundar Rao: I know of a physician who was nearing retirement and just didn’t want to do the full-time grind anymore. He moved somewhere that was a resort area and discovered that they had some needs on the outpatient side; they didn’t have that many physicians. He basically just approached the local hospital, which is not a big health system, and said, “I moved here, and I’m kind of retired, but I wouldn’t mind helping you and covering your clinic a couple of days a week. Let’s see how that goes.” He was actually able to get a really good deal for himself, and he enjoyed what he was doing, because it was completely flexible and part-time. And the hospital got what it needed, which was coverage. So that was one that worked out very well for both parties involved.

Kevin Pho: And Aaron, tell us a success story, perhaps from the surgical subspecialty perspective.

Aaron Morgenstein: If I could, I’m going to share two stories. One is about a surgeon who is nearing 70 years old. He quit his private practice after 30 years but still loves medicine and still loves doing surgery, so he started what I would refer to as a staged retirement. He reached out to hospitals and said, “Hey, I still have the skills to provide services. Is there any way we can work out a deal?” Instead of working every day as a private practice physician, he now works about one to two weeks a month. He’s very happy in his stage of retirement, he’s making decent money doing it and he’s still in the game.

I’ll share another story, not about a surgeon but about a younger physician who recently graduated from a hem-onc fellowship. Her priorities were to take care of her family and take care of her kids. She reached out to private practices and hospitals locally and was able to find opportunities to work just several weekends a month, rather than having to work a normal, traditional full-time employed job. She didn’t want to take a normal Monday-through-Friday hem-onc position, because she was more concerned about being there for her family.

Kevin Pho: So Aaron, from the clinician standpoint, there are the options of contracting directly with these facilities for part-time work, or locums. Contrast those two scenarios. What are the pros and cons of each? Because it sounds like, at least from the clinician standpoint, locums is the more expensive option. So tell us about the two scenarios physicians are confronted with.

Aaron Morgenstein: I think physicians want autonomy and flexibility, but they also want some degree of job security. If you’re going through a middleman, like a locums company or one of these private management companies, you don’t necessarily have that job security. You never know when the hospital is going to hire someone else to take over. So if you really want some degree of job security, you speak directly with these facilities to figure it out. Now, if you’re a physician who wants to bounce around, from hospital to hospital and state to state, then maybe working with agencies is best for you. But I’m not going to say that’s best for those facilities, because, as we know, agencies are very, very expensive for the system.

Kevin Pho: And Corinne, is this something physicians can do themselves? I know both of you offer consulting services to help physicians, but do they need a little more guidance when it comes to reaching out to these institutions directly?

Corinne Sundar Rao: I think they do. There are physicians who want to do this but just don’t know where to start. The best thing they can do is educate themselves about the various aspects of contracting: legal, staffing, malpractice, et cetera. The worst thing you can do is reach out when you’re uninformed, because then you simply don’t know what to negotiate. So there are physicians who definitely want to do this; they just don’t know where to start. I think it’s something that’s been under the radar. You don’t really hear about it, but you’re hearing about it more and more now, as people discover it, and I think it’s doable, for sure. Absolutely, it’s doable.

Kevin Pho: So Corinne, I just want to follow up. Tell us some of the issues or concerns that aren’t immediately obvious when it comes to these part-time direct contracting arrangements.

Corinne Sundar Rao: One thing, Kevin, is that they may not know who to reach out to, and they might not be able to get anywhere. Like Aaron said, you might be stuck with an in-house recruiter who may or may not be able to change anything in the job description, or you might just not be getting through to anybody. So that’s one thing. The second most important thing is that it’s hard to source these jobs. The locums jobs are posted, and you can find them, but somebody who needs you and is able to contract directly is harder to find. I think that’s where, again, contacts with other colleagues, networking and using the physician online spaces are all going to be helpful.

Kevin Pho: And Aaron, are you noticing any trends among the medical institutions and hospitals that engage in part-time direct contracting? Are they in urban or rural areas? Academic or private practice? Any trends you notice?

Aaron Morgenstein: If I’m seeing trends, they’re very small. I am seeing them in rural communities, usually in independent health care systems. So when I’m negotiating, or when I’m giving advice, I always tell folks to maybe not go after the largest health care system in their community. Go after smaller hospitals, or critical access hospitals, folks who are probably more open to working out an arrangement that works for both parties. I’ve also seen a recent trend of private practices opening themselves up to contracting with physicians, independent contractors, for part-time work, and to me it’s exciting that they’re opening up to that. So I think physicians need to know that when we’re speaking about working part-time, we’re speaking about working with health care systems and also with private practices.

Kevin Pho: We’re talking to Aaron Morgenstein and Corinne Sundar Rao. Aaron is an orthopedic surgeon, and Corinne is an internal medicine physician. They wrote the KevinMD article “It’s time for the C-suite to contract directly with physicians for part-time work.” Now I’m going to ask each of you for the take-home messages you want to leave with the KevinMD audience. Corinne, why don’t you go first?

Corinne Sundar Rao: For the take-home message, there are two audiences. To the C-suite, the admins, I’m just going to say: Be open to the possibility of contracting directly, because it may work out really well for you, and it probably costs less than paying middlemen. To the physicians, I’m just going to say, like I said before, educate yourself as much as possible, learn as much as possible and don’t give up. Just keep looking, and you’ll find something.

Kevin Pho: And Aaron, tell us some of your take-home messages, and maybe you could also share some resources for physicians who want to get started on this.

Aaron Morgenstein: I think physicians need to understand that starting new opportunities can be scary. We are handed many things in our medical careers. We’re handed an opportunity to go to med school, we’re handed an opportunity to go to residency, and then we’re handed our first opportunity to be an employed physician or go into private practice. It can be very difficult to jump to a new opportunity. So my recommendation to physicians is: Don’t rely on third parties. Don’t rely on staffing agencies. Make the commitment to finding your next opportunity, and start today. Don’t tell me you’re going to wait two years, or a year, until you’re fully burned out. Start looking into it now.

And when you’re doing that, make sure you find mentors. Just as in residency, when we had mentors who advised us on how to do surgery or treat the ICU patient, we need to make sure we have mentors guiding us to new opportunities, so we don’t get taken advantage of, and so we know there are opportunities out there that match or align with what we’re looking for. That’s what I focus on when we speak with other physicians: educating them about how to negotiate. What are your deal breakers? What do you want to include in your contract? What do you want the arrangement to look like, so it works for you and for the facility? Is it a culture you really want to be a part of? And other things, like how malpractice insurance is going to be dealt with. Understanding the terms, concepts and clauses within a contract is so important when you start speaking with these facilities. It’s important when you apply for your first job, and it’s really important when you try to go off on your own and create your own opportunity.

Kevin Pho: Aaron and Corinne, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.