They have huge debt, generally, and they're not sure when they'll ever be financially whole again, given the expected clampdown on their future earning potential.
In an excellent story in the forthcoming November issue of HealthLeaders magazine about the realities driving physician employment at hospitals, my colleague Karen Minich-Pourshadi says that the percentage of truly independent physicians, according to the American Medical Association, has been declining by 2% a year and is projected to decline by as much as 5% annually by 2013.
I can empathize that it's a dark landscape for some.
At least one relatively deep-pocketed organization is doing the best it can to hold back the tide not only of doctor departures from the field of medicine, but also departures for employment in big institutions.
"Because bigger is not always better," says Lou Goodman, president of the Physicians Foundation, a nonprofit grant-making entity that was formed with a $115 million endowment. The endowment came from a group of physician societies who won about $1.5 billion in retrospective and prospective relief resulting from a class action suit in 2003 against several major insurance companies.
Physicians alleged, successfully, that the companies were using a hidden system (colloquially called a black box) to deny reimbursements to which physicians were entitled under their contracts with the insurers.
The foundation has awarded about $28 million in grants since its founding, and usually funds research and ventures that are in the business of keeping physicians who want to be independent.
"All the incentives are arrayed against it," he says. "We're collecting information, through our medical practice task force, with a survey of young physician needs. They're not seeing a lot of alternatives to employment."