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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022
| Contributor Information
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
Employed physicians are often torn. Many relish the steady salary and ability to focus on being a physician, leaving administrative decisions to others. But they bemoan their employers' rules and regulations and their lack of input into key decisions, and they disagree with many management decisions they think benefit the organization rather than patients or physicians.
Medscape surveyed more than 1350 US physicians employed by a healthcare organization, hospital, large group practice, clinic, or other medical group about the pros and cons of their jobs, income satisfaction, job security, attitudes toward their employer and its rules, future career plans, and other key topics.
(Note: Some totals in this presentation do not equal 100% due to rounding
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
"When my firm talks to employed physicians about why they took their job, not having to run a small business is their broad-brushstroke answer," says Tony Stajduhar, president of Jackson Physician Search in Atlanta. "There used to be a cyclical trend: Every 10 years, lots of physicians would get sick of administrative responsibilities, and many of them would gravitate to an employed situation. When the Affordable Care Act came out [in 2010] with record-keeping fines, this was the catalyst for many physicians to say, 'I'm done with this' permanently."
When Medscape surveyed employed physicians in 2014 about the most rewarding parts of their jobs, letting someone else run the business also topped their lists. Stable income also was near the top.
(Respondents could make more than one choice.)
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
The three downsides physicians chose most often were reporting to decision-makers, working under corporate rules, and less ability to control their compensation.
"Doctors like their autonomy and don't like being told how to practice medicine," Stajduhar says. "It rubbed them the wrong way 20 or 30 years ago when companies were acquiring medical practices. Doctors started reporting to businesspeople and they were being called 'providers.'"
"Today, a lot of doctors are willing to accept such things and take the sure thing, even if it doesn't make them as happy."
(Respondents could make more than one choice.)
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
In June 2022, staffing company Insight Global took a survey in which 78% of US employees worried about losing their job if the economy plunges into recession. In contrast, physicians seem much more confident that nothing will happen to their job with a hospital, corporate healthcare provider, or other business entity.
"As long as people have healthcare needs — which will always be the case — the healthcare sector will navigate recessions and economic downturns better than many other sectors of the economy," says Robert C. Scroggins of ScrogginsGrear, a Cincinnati accounting, tax, and management consulting firm specializing in physician and dentist clients.
As for the 16% who feel insecure, "this could be due simply to being an employee instead of a practice owner or may also reflect businesses releasing certain specialties for strategic reasons or individual doctors due to subpar performance."
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
Nearly 7 in 10 physicians surveyed don't envision their career with a healthcare organization lasting more than another 10 years. But the same can be said of staying in a self-employed doctor situation longer than another decade (69%).
Such numbers in part reflect an aging population of US doctors, with many starting to contemplate retirement, Stajduhar says. But also, his firm has interviewed a number of physicians recently, and it's difficult to overstate the pervasiveness of burnout, he warns.
"You already had a lot of physicians starting to talk about leaving medicine altogether before COVID-19. Then the pandemic took so much of the joy that was left in practicing medicine. It was a horrible 6- to 12-month period that I think left many physicians with PTSD and has taken the disaffected feeling much higher than I've ever seen it in my career."
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
Nearly 7 in 10 respondents don't envision working more than another decade as an employed physician. What might be next? Nearly 30% of them see retirement on the horizon. Also, almost as many would get out of medicine as would work in private practice.
"A lot of physicians who talk about retirement or a different career would be willing to stay in medicine on a part-time basis with a reduced workload and less pressure," Stajduhar observes. "There's a great opportunity to start making this a reality. The conversation with healthcare organizations just needs to be different. We have too big a shortage of physicians already."
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
Contentment with compensation among employed physicians has grown somewhat since 2014, when 49% of them told us they were at least satisfied. The same proportion of employed doctors is unsatisfied, in varying degrees, today with their income, and a smaller percentage is neutral. Meanwhile, 65% of self-employed physicians tell Medscape they are now satisfied or happier with their compensation.
"It varies with the individual physician, but income may not be the main driver for some of these people," Scroggins says. "Many are happy with their employee salaries and are more focused on avoiding the extra [administrative] activity that comes with private practice. Plus, I see more hospitals becoming more competitive with compensation for their best doctors and highest producers."
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
The healthcare marketplace constantly evolves. In our 2014 report, 46% of employed physicians drew a straight salary and 13% got a base salary plus productivity targets and other performance metrics.
"As initial physician contracts end and renewal contracts begin, you see salary plus productivity included as an incentive for both high and low performers," Scroggins says. "For high performers, the productivity component is in response to competition from the income [upside] advantage available in private practice. The model also influences other doctors to perform better."
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
About 3 in 4 employed doctors have a positive, or at least neutral, view of the fairness of the targets and metrics their organization uses. They may feel more upbeat than do employees in other American industries. In a McKinsey & Co. survey, many respondents felt their organizations' performance management policies and systems either had no effect or actually drove down results.
These targets and metrics have a long enough track record in medicine now that employed physicians take them in stride, Stajduhar believes. "They accept that this is the world they know and it's probably fair." Plus, more healthcare CEOs and practice leaders are getting more creative with retention bonuses and quality metrics that incent doctors for the right reasons — and are consulting with physicians about how to structure them, he says.
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
Achieving work-life balance is never easy for a physician working at a healthcare organization, and the COVID-19 pandemic's pressures didn't help. Compared with our 2014 report (19%), a greater share of employed doctors feel unsatisfied or worse about their work-life balance, and about the same share (54%) feel satisfied or better.
The stakes for failing to find that balance are high. The Medscape Physician Burnout & Depression Report 2022 found that burnout has a strong or severe impact on the lives of more than half of doctors and negatively affects their personal relationships.
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
Neither employed nor self-employed physicians seem to feel they have an advantage for the much-coveted balance between rewarding professional and personal lives. For self-employed physicians in this survey, the comparable percentages are 49% better, 34% about the same, and 18% worse.
Younger physicians in particular value work-life balance highly. An American Medical Association survey found that 92% of doctors under age 35 feel that balance is important.
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
Clearly, most doctors working for healthcare organizations have achieved a level of comfort with the company culture. Some of our respondents would substitute "pragmatism" for "comfort."
"The culture at my workplace is that administrators make decisions, and the clinical staff carry out those decisions."
"You have to accept the culture of an organization with which you do not always agree."
"An institutional culture does not always put patient care first (ie, money before patients)."
(Neutral responses are not shown.)
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
Both employed and self-employed doctors see effective collaboration at their workplaces. But the latter are even more positive: 86% of self-employed physicians tell Medscape physician-staff collaboration is effective or very effective.
(Neutral responses are not shown.)
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
Employed doctors' feelings about their levels of autonomy in the organization haven't varied much in recent years. Their expressions of satisfaction or dissatisfaction are about the same as in our 2014 report (49% and 25%, respectively).
(Neutral responses are not shown.)
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
A substantially higher share of employed doctors go to work facing no daily patient quota, at any number, than in our 2014 report (41%). "My schedule is flexible. I do not have to worry about meeting quotas for payment/bonus," one survey respondent says.
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
One advantage to working for a healthcare organization is that you usually put in fewer on-call nights than in private practice. Nearly 7 in 10 employed doctors (compared with 55% of self-employed physicians) put in five or fewer on-call nights per month or none at all. Plus, about 1 in 5 physicians in private practice handle 16 or more on-call nights each month.
"When I am gone from work, I can be fully present at home, no on-call duties," enthused one respondent.
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
Many employed physicians frequently feel that their workplace rules are more sensible for patients and the company than for themselves.
"The work of a physician is by nature primarily autonomous, and being under the direction of an institutional employer can feel like interference with the physician's autonomy," Scroggins says.
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
Many employed physicians don't seem to feel they have an impactful voice in how their healthcare organization is run. "Often, the physician comes out of the pre-hiring discussions with their future employer believing they will have significant management influence," Scroggins says. "But it rarely unfolds that way."
When it doesn't, "it can be particularly frustrating that others are making management decisions that…impede their ability to deliver excellent patient care."
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
Healthcare organizations could do more to discourage employees from coming to work sick by improving sick day benefits, some respondents said.
"I am a hospitalist, and we literally only get 2 days of sick paid leave per year. And we had to fight for that; we had none for the previous 20 years," one physician complains.
"I have not called in sick for myself or my own family in the past 18 months," another says.
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
While nearly 7 in 10 employed doctors say their companies respond with a warning and/or suspension, it's noteworthy that almost 3 in 10 say individuals are encouraged to work things out and/or nothing happens at all.
(Respondents could make more than one choice.)
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
"Physicians have had a lot of years to let attorneys review several iterations of their work contracts, so the clauses have become mainstream," Stajduhar says. "But I still do see a lot of noncompete clauses in contracts that I'm surprised physicians don't push back on more."
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
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Employed Physicians Report: Loving the Focus, Hating the Bureaucracy
Jon McKenna | September 2, 2022 | Contributor Information
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