The Other Physician Shortage

Elyas Bakhtiari, for HealthLeaders Media, April 3, 2008
Physician shortages are typically discussed in terms of quantity. We look at the static number of physicians entering the work force in relation to the rising demand for medical services. Last week I wrote about this topic by examining different specialties' effectiveness at recruiting medical students.

But there is a quality angle to it as well. A portion of the manpower shortage is tied more to how physicians work than the sheer number of physicians. The problems in care delivery wouldn't entirely vanish even if we somehow increased medical school enrollment overnight and injected new physicians into the work force. Today's doctors simply aren't collectively as productive as in the past, which means we need more physicians to treat the same number of patients as before.

This trend is partly due to a generation gap--Senior Online Editor Rick Johnson wrote a few months ago about Generation X and Y doctors' preferences for shift work and work-life balance. But the change can't be explained by that alone. Physicians of all ages are fed up with the business aspects of medicine and revolting against expectations of providing call coverage. More physicians, both older males and younger females, are also working part-time--nearly one in five according to the Cejka Search/AMGA 2007 Physician Retention Survey.

So facilities must adapt. I've been listening to Laura Boehlke Bray, MD, tell her story over the last few weeks as we've been preparing for next Wednesday's audioconference about part-time physician compensation, and I am impressed by how physicians and the administrators at her facility have been able to overcome some of these productivity challenges. She is a clinic chair with Duluth Clinic in Minnesota, which operates with one-third of its physicians working part-time. That's a lot of part-time employees for any business, let alone a physician organization. And the proportion is expected to increase in the near future, Bray says. Many of the clinic's physicians are in the demographic groups most likely to work part time; 45% of physicians are already 55 or older, and 60% recruited in 2007 are female.

How are they able to operate on a model that would have been inconceivable a few years ago? Duluth Clinic leaders have adapted by changing their attitudes about part-timers, she says. Without accommodating part-time schedules the clinic wouldn't be able to remain open, so leaders have made a conscious effort to value these physicians by redefining full-time equivalent and developing new operational and compensation plans.

Granted, with more than 400 physicians, it is easier for an organization like Duluth Clinic to diffuse potential costs associated with part-timers than it would be for a smaller medical practice (though managing roughly 130 part-timers isn't a simple task). But organizations of all sizes are going to feel the effects of the growing part-time trend and the lower productivity of today's workforce.

It's better to plan now before it becomes a full-time problem.

Note: If you'd like to hear more about how Duluth Clinic compensates its part-time physicians, there's still time to sign up for Proven Strategies for Part-time Physicians, a HealthLeaders Media audioconference on April 9 at 1 p.m. (EST).

Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at
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