The healthcare landscape will continue to consolidate through physician employment and new practice choices from medical students in 2015 and beyond.
Physician employment at larger healthcare organizations will increase rapidly in 2015 as consolidation of providers and financial pressures squeeze private practices into closing their doors. Between the anticipated costs of ICD-10, changes to reimbursement structures that promote value-based payments, and a desire for more care coordination by working in extended teams, new medical students and established practitioners alike are leaning towards banding together in larger, more stable groups.
“The coming year will again be one of major transition for the U.S. healthcare system,” said Lou Goodman, PhD, president of The Physicians Foundation and chief executive officer of the Texas Medical Association. “Regulatory and marketplace forces are having a number of unintended effects, including challenging the viability of smaller medical practices, reducing patient choice and putting tremendous strain on the physician-patient relationship.”
The Physicians Foundation envisions several key challenges for providers in the next year, including external pressures on the patient-provider relationship that make practicing medicine less satisfying. Even though one recent study states that physicians are actually spending more time with each patient now than they did a decade ago, continued dissatisfaction with the intrusion of EHR documentation on the workflow and other regulatory pressures are driving unhappy physicians to retire, seek employment with fewer administrative burdens, or reduce their availability.
Physicians who seek employment at bigger health systems tend to report higher levels of job satisfaction and more time to focus on the patient relationship, the ACPE found earlier this year, but must also contend with the downsides of being a smaller piece of a more complicated system. Employed physicians are more likely to report feeling unheard and unrecognized for their achievements. Physicians at private practices that have been acquired by larger health systems feel poorly integrated and complain about a lack of cultural alignment that would incentive them to perform at their best.
Medical students and new physicians are pinning their hopes on the benefits of employment, however, says a separate report from EHR developer athenahealth. The Epocrates Future Physicians of America survey found that ninety percent of medical students will not go into private practice, which is a fifty percent increase from 2008. Students desire the financial security and work-life balance of employment in larger facilities, and want to avoid the difficulties of being a small business owner in addition to a full-time physician. Part of this pattern is due to inadequate instruction during medical school on how to operate and manage an individualized practice, according to nearly 60% of respondents.
In addition to feeling poorly prepared for being self-employed, medical students recognize the importance of working in larger teams with better communication and more non-physician support. Care coordination is top of mind for 96% of these newly minted MDs, and 75% believe that better coordination is dependent on EHR data sharing, interoperability, and health information exchange.
As physicians adjust the way they practice to take advantage of more modern expectations of being valued, balanced, and engaged in the workplace, their needs must be addressed in order to maintain high levels of patient care and sufficient access to healthcare for the millions of newly insured citizens under the Affordable Care Act, Goodman says. “It is paramount that policy makers bring physicians into the fold to ensure the policies they implement are designed to advance the quality of care for America’s patients in 2015 and beyond.”