Medicine

Should Docs be Employees?

By Chris Rangel MD ⋅ July 16, 2007 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

The problem with employee physicians - [NOTE: The following is based on my experiences as an internist and hospitalist]

So, you are nearing or at the end of your medical training and you can’t decide what type of job arrangement to enter into. Should you start your own practice, join a practice, or get hired as a salaried employee of a hospital or other company? Before you sign that contract in blood you might want to read the following.

I was an employee working as a hospitalist for about 5 years. The good part was that all my paperwork (and overhead) was taken care of and I was guaranteed an income. The bad part was that I was essentially on a salary (the bonus options were usually small). This hurt when I was very busy. To me this arrangement acted as an anti-incentive and it decreased morale.

Another negative of being an employee was that the loss of control you have over the course and management of your practice (i.e. how busy you want to be). Still another negative is that (in my experience) companies with physician employees tend to have much higher rates of physician turn-over than physician owned practices where the docs are full or partial partners. This can lead to continuity of care problems.

The main problem for employee physicians is related to the employer-employee relationship and the fact that the priorities of both are different. The main goal of the employer is to maximize profits and minimize costs but often this leads to excessive workloads where the compensation is almost always less than what the doc would be able to take home if they were self-employed. This easily happens because the demand for physician services usually exceeds supply and the practice of medicine is almost never a 9-5 job. Usually physicians are reluctant to insist on workload limitations in their employment contracts out of concern that they won’t be hired (or looked down upon as being “lazy”).

These situations lead to a poorer quality of life and to lower job satisfaction where the physician feels overworked, underpaid, and powerless to do anything about it except quit. This in-turn eventually leads to high rates of physician burn out and high rates of job turn-over. Many of these physicians come to the realization that the benefits of being an employee do NOT outweigh the risks and hassle of being self-employed.

Unfortunately, many of the employee physicians who have a bad experience with one job tend to change to a job where they are guaranteed a far more comfortable work load (usually no call with weekends off) for a reasonable salary. They have learned that more work does not necessarily lead to comparable salaries and that companies that promise big incomes usually deliver unmanageable workloads that significantly and negatively impact the physician’s quality of life. Even with the higher income it’s a tradeoff that many employee physicians don’t want to take.

For physicians, job satisfaction comes first. We all have gone through way too much education and training to be stuck in a job where we feel overworked, underpaid, undervalued, and limited in our ability to change or manage the way we practice. I worry that far too many physician employers are taking advantage of young (and naive) docs fresh out of training thus leading thousands to conclude that working hard is no longer a rewarding virtue in the medical profession.

Over time this can have the effect of worsening physician shortages and access to health care as more docs work less (this is analogous to what will inevitably happen in this country when and if we change over to a socialized health care system where all physicians are on salary).