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Healthcare Reform Influencing Physicians' Career Choices

Healthcare Reform Influencing Physicians' Career Choices

Following a four-year overseas tour in the Army, family physician Beau Ellenbecker opened a two-physician practice in Roanoke, Texas, in August 2011. But Ellenbecker opened the practice not as an owner, but as an employee of a large healthcare system.

"I think doctors in past generations were a little bit more entrepreneurial," he says. "When they went into medical school their desire was to own their own practices, and nowadays that thought didn't occur to me." Instead of practice ownership, he says, he wants assurance "that my employees are going to get paid, that I don't have to bleed my knuckles to make sure that all my overhead is covered and whatnot, and then worry about where my paycheck is at the end of the day."

Ellenbecker's preference for employment is one of many major shifts in attitudes toward work and life underscored by the results of our latest Great American Physician Survey of U.S. physicians. More of you are pursuing less demanding work schedules and exploring new models of care while feeling less optimistic about the future of medicine in general.

From generational differences and uncertainty due to healthcare reform to skyrocketing stress and frustration with traditional fee-for-service reimbursement, here's a look at some of the key factors that are changing your attitudes and career preferences.

*To read the results of the 2012 Great American Physician Survey view our slideshow here.

Ease of employment

Twenty-nine years ago, family physician Robert Carter opened a solo practice in Savannah, Ga., and he's happily practiced there ever since. "It was just one of those things that when I finished school, it wasn't written in stone, but many people started their own practice or went into other small practices," Carter says.

Now, with his two children in medical school, the 60-year-old sees how much things have changed. Though neither of his children has decided whether they prefer employment to private practice, most of their peers have. "Both of them had opportunities to work in my office for many years as they were growing up so they know what it's like, but they hear everybody — all their classmates — talking about 'I wouldn't dare consider going into practice for myself,'" says Carter.

This sentiment among young physicians has skyrocketed over the past decade. In 2001, only 3 percent of final-year medical residents said they would prefer hospital employment over any other option; in 2011, 32 percent said they would, according to physician search firm Merritt Hawkins' annual surveys of final-year medical residents. "Residents told us we're ready for the practice of medicine, but we don't want anything to do with the business of medicine," says Kurt Mosley, vice president of strategic alliances for Merritt Hawkins.

Young doctors worry that practice ownership will mean too much time spent on administration, too many long hours at the office, too much stress and financial risk. Employment just seems safer and simpler. And while previous generations of physicians were more willing to accept those presumed drawbacks because it meant independence and potentially higher incomes, younger physicians have different priorities. "I definitely think that their preference is this lifestyle/work-balance area," says pediatrician Walker Ray, vice president of The Physicians Foundation. "I think they have looked at physicians' practices and the practice styles in the past and said, 'That's not what I want to do, I don't want to work a 60- or 70-hour week.'"

Indeed, only 4 percent of Great American Physician Survey respondents over age 65 said they would give up partnership in exchange for a reduced workload. Yet 21 percent of our respondents under age 35 said they would.

Solo family physician James Robusto, who has practiced in Urbanna, Va., for 26 years, worries that young physicians are missing out on the fulfillment gained from working in a private practice. "When I'm working for myself, I know for one thing that the patients come first, and that is simply the way it's going to be," he says. Still, he acknowledges that entering private practice today is more challenging than it was in the past. "…The government regulations are now a lot worse than when [older physicians] first came out," says Robusto.

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