Pinnacle Health Group’s (PHG) annual survey on ‘why physicians leave’ reinforces the industry’s outlook that compensation and work-life balance are main reasons why physicians leave their practices. The survey, which was sent to over 6,000 physicians across the nation between February and November last year, also revealed that 52% of the surveyed doctors are uncertain of the potential changes in healthcare delivery because of the recently passed healthcare reform bill.
When searching for another position, 29% are struggling to find another practice because of the difficulties of today’s housing market, while 22% of the respondents do not have the resources to relocate. 30% of the surveyed physicians, on the other hand, are working stably in private practice or as hospital employees.
Conversely, respondents cited compensation (56%) and call coverage / workload (56%) as major reasons ‘why physicians leave’ their practices. One doctor related, “I truly think the current housing market has made it impossible for many physicians to relocate. Practices/hospitals may need to do what many industries do and purchase homes from physicians. I have personally turned down jobs because I did not think I could sell my home and did not want the hassle of two mortgages for any length of time.”
Compared to PHG’s 2008 survey, where geographical, family-related concerns, and ‘desire for another climate’ were the main reasons for leaving, this year’s survey cited the ‘lack of autonomy or control in their practices’ as a significant factor when they look for new practice opportunities (44%). This was closely followed by the ‘lack of professional appreciation,’ (43%) malpractice premiums (34%) and ‘poor working relationships with the hospital administration’ (34%).
Respondents say a ‘lack of autonomy,’ ‘professional satisfaction’ and other related concerns, are motivated by compensation issues and the uncertainty of today’s industry. One physician said, “In private practice and university-based models, excessive workload and poor compensation, especially for cognitive activities, fuel a desire to leave. The incentive is to perform procedures and order tests independent of their need or risk. This is true for sub-specialties like neurology, nephrology, endocrinology and genetics among others—they are not being motivated by supply and demand forces. Ultimately they are given little say in their own practices because the current reimbursement environment does not adequately compensate for the expertise. This makes most physicians mere technologists or triage officers which is inherently unsatisfying. We need a new program that rewards cognitive efforts and deemphasizes procedures and testing together with a system of fair compensation that reflects quality of care first followed by years of training and years in practice.”
PHG’s Chief Operating Officer Michael Broxterman remarks, “This year’s survey clearly reflects the shift of physician expectation and viewpoint. They are so much different than in the past years. I think it’s been established how important the balance between career and personal life has become, along with compensation, malpractice, tort issues, and employment arrangements. However, the healthcare reform bill has definitely made big changes in expectations, particularly in service delivery. In fact, the recent survey shows that more than 50% of healthcare organizations are affected by it, too.”
One doctor related, “I left private practice several months ago because I could no longer afford overhead costs. These costs increase yearly, and include increasing regulatory burdens imposed by the government. This occurs at the same time that reimbursements are declining below the cost of the delivery of care. I have some protection now as an employed physician, but my former office staff is now unemployed and even now I don’t know how long I will be able to keep practicing. Many physicians I know are considering leaving practice as well.”
Survey results also showed that physicians who leave to look for new jobs also want to proactively communicate with the recruiters and the healthcare facilities, particularly when taking into account their preferences when looking for new practice opportunities.
Broxterman concludes, “What makes physicians leave is probably the combination of regulations, financial constraints, professional and personal restrictions, and preferences. Healthcare organizations must address these in order for them to maximize productivity—such as maintaining their quality of life, increasing value-added service lines to grow their income and objectively evaluating productivity, among others. For physicians, the motivation to want their practices to thrive and succeed in today’s marketplace in itself is an encouragement in the sense that it will ultimately benefit the community.”
Survey Results:
| What reasons do you believe why physicians leave? Note: Respondents were given options to mark all that apply. |
|
| Compensation | 56% |
| Call coverage / workload | 56% |
| Lack of autonomy / control in my practice | 44% |
| Lack of professional appreciation | 43% |
| Poor working relationship with the hospital administration | 34% |
| Malpractice rates / premiums | 34% |
| Opportunity to advance in career | 32% |
| Highly litigious malpractice environment | 31% |
| Poor working relationship with colleagues / medical faculty | 29% |
| Uncertainty of potential changes in healthcare due to the coming reform | 28% |
| The need to secure income by employment as opposed to a private / solo practice |
27% |
| Current job not utilizing all of my medical skills and expertise | 26% |
| Current practice is declining / restructuring | 25% |
| The need to be closer to family and/or friends | 24% |
| Desire for another climate | 18% |
| Family is not comfortable in the community |
18% |
| New practice environment to enrich my experience |
9% |