Young Doctors Disgruntled, Determined

The Caring for Women, PA obstetric and gynecologic practice in Denton, TX, helps newborns begin smoothly in life, but the physician group itself is struggling to survive.

The small practice faces constant fiscal challenges and has made cutbacks to salaries and retirement benefits amid worries that the physician group may be nearing its end. The Caring for Women practice's difficulties reflect those faced by small physician groups across the country who wonder whether they should join bigger, high volume groups, or even get out of the caring for people business altogether.

The practice is not comprised of grizzled veterans who have seen enough and are ready to make a change. Rather, these are physicians who only started out in the 1990s, and are thinking of bailing out already.

Joseph S. Valenti, MD, FACOG, one of four practicing doctors in the group, handles the administrative duties for the organization, which also includes three midwives, a nurse practitioner, and other staff.

Now in his early 40s, Valenti easily lists why he and his colleagues are reconsidering the future of the practice. "My income in the last five years has gone down 33%, and my overhead has gone up 50% every year," Valenti tells HealthLeaders Media.

"The physicians in the group decided to take a pay cut. The physicians also took almost $80,000 out of their own retirement fund. It's a challenge to find more places we can cut, still keep good people in the office, and see patients appropriately. It's becoming harder and harder."

Facing uncertainty, Valenti's somewhat pessimistic attitude about his future mirrors the view of many young physicians. Last month, a survey of 500 doctors by The Physicians Foundation showed that 57% were pessimistic about the future, with 30% saying they were "highly pessimistic," citing the new healthcare law or regulations as key reasons for their discontent.

Unlike Valenti, as many as 80% of doctors surveyed expressed satisfaction with their current arrangements, with 35% saying they are highly satisfied. At least 39% say they aspire to some form of ownership position in the future, either as a sole owner or partner.

The typical survey respondent was an employee of a medical group. When asked about the Affordable Care Act, 49% said they believe the impact on their practice will be negative, and 23% anticipate that it will be positive.

About 27% of the physicians surveyed say they are changing or considering changing their practice or employment arrangements over the next year because of "financial issues."

Lou Goodman, president of the Foundation, says he was surprised and troubled by the findings that young physicians are so disgruntled about what they believe the future holds in their profession—especially since people are applying to medical schools in record numbers.

The number of applicants applying to U.S. medical schools was 43,919 and reached an all-time high in 2011, according to the Association of Medical Colleges.

"There are more applicants than ever," Goodman says. "So people are very excited about medicine; it's still the best and the brightest. It's a huge investment of time and a $200,000 plus debt. But they have these unmet expectations. Their expectation is, 'I've gone through this, I am a trained practitioner, yet I don't have the opportunity I want. There is this bombardment of regulations."

Reluctance toward hospital employment
The survey also shows perceived reluctance among young doctors about hospital employment. While 31% of the hospital-based respondents are employees of a larger group, only 12% would prefer such an arrangement, and they say they are more likely to spend two years or less working at a hospital. Most medical surgical office-based physicians say they would spend up to eight years or more at those positions.

That doesn't bode well for hospitals, Goodman says. The young physicians may feel they have more opportunities to work in a hospital, but feel "that is something I want to do on a short-term basis, and I'd rather work with other doctors in a collegial relationship."

"By saying they want to stay only two years in a hospital, what are the implications of that for a patient?" Goodman asked. "We have said for years that we need continuity of care, and make sure care is accessible and affordable, but I think this is contrary to what people are seeking. And if these doctors are pessimistic, and they have gone through all this incredible training and feel their expectations are not being met, we have a national problem. Already, we have a shortage of 150,000 primary care physicians, and then we will have 30 million more (insured patients) from the Affordable Care Act. We will need more doctors. Whether this is a passing attitude, or because of this particular time in our history, I don't know, but I'm very surprised at the level of pessimism."

Oddly enough, the survey findings fly in the face of what some hospital officials are reporting about young physicians. Indeed, many physicians and hospital leaders I've spoken to are optimistic about the attitudes of young physicians.

For one thing, in hospitals, many are likely candidates for multidisciplinary approaches, more suitable for team-based care that is being promulgated throughout healthcare. And many of these physicians may have less of an inclination toward burnout in their work habits, in part, because they don't want to work all those crazy hours they observed their older compatriots working. It's important to the younger doctors to have "a life."

Valenti, the Texas physician, says he understands why many of the young physicians are disgruntled, as he is, and he's surprised there aren't more. But Valenti, who volunteers for the Physician Foundation, and his colleagues aren't giving up their practice without a fight.

Recently, the practice opened its doors earlier and kept open the lunch hour to serve more patients. "To keep our practice alive, we varied our hours to accommodate patients more, [that's] one of the things we are doing to stay afloat as a private practice," Valenti says.

In the meantime, the physicians are going to meet with insurers and discuss reimbursements, Valenti adds. "We are going to the pull out our data and show we're doing as good as we can, and we do a great job with patients," he adds.

If the group doesn't make headway to improve its financial situation, "we're going to look at the administrative cost of joining a group that has better contracts than we do. I don't know what else to do,"

Valenti is a young doctor, but the profession has gotten him older.

"There was a time I felt a little bit sad and angry," Valenti says, "And now I feel determined."