Newly minted physicians are displaying a generational shift in their overall work philosophy. They want to be employed following residency not only to focus more intently on patient care but also to give their lives stability. Newer physicians don't have the desire to continually work 80-hour weeks and instead strive for a work-life balance, says Britt Berrett, PhD, president of Texas Health Presbyterian Hospital Dallas, an 898-licensed-bed acute-care hospital with more than 800 employed physicians and physician extenders within the Texas Health Resources healthcare system.
Recognizing the mind-set of the generation you're hiring, Berrett says, is an ingredient that shouldn't be overlooked. Moreover, while hospitals may wish to hire a physician to fill a service line gap, a new physician won't come with an established patient base, which can slow referral revenue and productivity.
"The new generation of physician has significantly different expectations than physicians of the past," Berrett says. "These physicians have a tremendous desire for work-life balance, and it seems the lion's share of these new physicians prefer the stability of being part of a bigger system."
More experienced and established physicians also bring their own pros and cons. The changes in healthcare are making the small practice setting more administrative and disenfranchising these doctors from maintaining their own practices. It's now more expensive and even more time-consuming to operate a practice. Employing these established doctors means a hospital must create a contract that provides financial security but also allows for autonomy. And a greater challenge lies in guiding the physician toward meeting the organization's goals.
"Some of these physicians want to slow down and have some more personal time, but what we find is more often the physicians who have been in practice for a while want to concentrate on the complexities of medicine and don't want to deal with the changes to the revenue cycle and the billing. Gone are the days when the physician's spouse could do all the billing," notes Berrett. "These folks are coming to us to provide the backbone and infrastructure they need to keep their focus on practicing medicine. They want to use their MD and not have to get an MBA to do it."
Employment versus joint venture
Berrett says that employment, as opposed to a joint venture, offers the physician and the practice other benefits such as better pricing on an IT platform and more sophisticated revenue cycle and collections.
In addition, the strength of employment comes from having a contractual tie to an individual, whereas a joint venture tends to be with an entity that has multiple partners. "Sometimes an employment agreement with a singular physician can be less complicated and move forward more easily than trying to create a joint venture," adds Julie Manas, president and CEO of Sacred Heart Hospital in Eau Claire, Wis., and division president and CEO of the Western Wisconsin division of Hospital Sisters Health System. The 344-licensed bed acute care Sacred Heart is an affiliate of the Hospital Sisters Health System.
Sacred Heart employs just 20 physicians and adds to those numbers judiciously based on market factors, Manas explains. Sacred Heart is situated near the Marshfield and Mayo clinics as well as the University of Wisconsin-Eau Claire medical school and the OakLeaf Surgical Hospital and Medical Network, a 200 physician-owned organization.