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Doctor-Hiring Rush is On

Karen Minich-Pourshadi, for HealthLeaders Media, April 2, 2013

"Having 20 employed physicians may seem low, but that's nearly doubled from what we had recently—mostly in primary care. Employing wasn't something we've done. We have approximately 300 physicians practicing with us, but many of the physicians are on the clinical council at other hospitals or have joint ventures with other organizations. We have to be mindful of our market and the need."

Employing physicians can seem like a great option, notes Manas, but it's not always the best one. James Jarrett, president of the New Jersey ProCure Proton Therapy Center, part of ProCure Treatment Centers based in Bloomington, Ind., agrees, noting that joint ventures can offer a different level of motivation for physicians. The New Jersey facility opened in March 2012 and Jarrett was responsible for staffing. With a private equity background, he had the bottom line firmly in mind when the organization opted to not employ physicians, instead favoring partnerships.

"We don't employ any physicians in this entity, though a lot of doctors do ask me about it, as do a number of our hospital partners. Employing physicians is very much top-of-mind. But we partner or use joint ventures with our physicians," he explains. Our doctors are part owners, and we feel it will drive better longer-term patient care behavior."

Though the joint venture agreements vary based on geography and state laws, physicians with ProCure don't have to participate in the business side of the operation and are concentrating on treating patients. Jarrett notes, however, that for previously independent physicians these arrangements can allow the doctor more independence while encouraging them to help the organization grow.

"Employed physicians may find they have to participate in broader health system initiatives, and not every person will agree with every initiative. Doctors may be expected to keep referrals in-network, or the physician may have certain objective targets to meet. It can give the physician an overall feeling that they are being driven by profit, whether that's true or not," says Jarrett.

Reform and the ROI equation

Mark Browne, MD, MMM, CPE, FACPE, is senior vice president and chief medical officer at Covenant Health, a Knoxville, Tenn.–based system that includes seven acute care hospitals in East Tennessee and employs 125–150 physicians, 70% primary care and 30% specialty. He notes that defining the clinical and financial rationale for employing physicians is still driven by the market demand and clinical need to fill service line gaps.

"We have to assess the clinical need for the community. Employment is rarely our first choice, but given a particular physician or the circumstances, such as an underserved population in a particular specialty, then we certainly put employment on the table, but we want an agreement that leads to strong long-term alignment," says Browne.

Still, healthcare organizations need to make margin, and attaining an ROI for these physicians is important. "These days, the best way for us to measure ROI is by tracking the quality of care of the physicians, though that doesn't always visibly connect with the financials. Part of the secret sauce is to partner with a physician who wants to achieve the same outcomes you want. That leads to better ROI and lower costs," says Browne. "Tracking the ROI from physician employment isn't as linear as buying an MRI and tracking use."

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4 comments on "Doctor-Hiring Rush is On"


Dr Bob (4/28/2013 at 7:49 PM)
"healthcare reform as the time that not only made improvements in the quality of patient care " Karen, with that one statement in the opening sentence I realized you are clueless re medical care, the determinants of health, and the intent of the "Affordable Care Act" Dr Bob

Paul Schwartz (4/3/2013 at 9:29 PM)
The current trend in employment opportunity for physicians, while unarguable, is certainly both disappointing, and worrisome. The pure employment model of healthcare is not what the average U.S citizen desires, or expects. Think Canada, think V.A. hospital, think Kaiser. Low production models that save money primarily by limiting access to services. Certainly some organizations such as the Mayo Clinic, and Cleveland Clinic have been very successful with an employment model and provide superb medical care, but these are definitely in the minority, and, are at their root, superb examples of private practice medicine expanded to offer large arrays of service, rather than a hospital organization seeking to capture market share. We have resisted this change, as a medium sized multispecialty group practice, but are certainly worried by the seeming ignorance of the federal government and it's inability to recognize and treat the real problems that exist in today's health care in the United States. I hope that at some point both the government, and the populace in general will begin to recognize the worth in having hard working, independent physicians, who care most for the health of their patients, and are willing to devote time and money towards research and exemplary health care, rather than encouraging an entire army of complacent, unmotivated physicians simply collecting a salary from the hospital behemoth that is controlling all of medicine in it's own best interest.

Greg Mercer, MSN (4/2/2013 at 7:18 PM)
Physicians had their time of power and prestige, and they gave it away for all the money thrown their way by all the insurance and Pharma conflicts of interest they have become quite addicted to as a group. The loss of credibility and presitige that has resulted has, at long last, beugn to seriously erode physician power, autonomy, and incomes. You reap what you sow, and power lasts only as long as you maintain it: take it for granted for an few generations and poof! It's gone.