On top of this, dealing with governmental regulations can be daunting. "New practice owners have to know how to navigate the Medicare Access and CHIP Reauthorization Act (MACRA), the Merit-based Incentive Payment System (MIPS), and Meaningful Use criteria, and have an EHR system that is compliant per CMS," says Singleton "They will also need coding expertise because CPT codes are complex, as well as a legal team for general business purposes, such as compliance with employment regulations."
Lack of Training to Run a Practice
Not knowing how to start and operate a practice is also a deterrent. About half of residents (49 percent) in the Merritt Hawkins' survey said they didn't receive any formal instruction during their medical training regarding medical business issues such as contracts, compensation arrangements, and reimbursement methods. Furthermore, over one-third of residents (38 percent) said they felt unprepared to handle the business side of medicine.
"Over the last couple of decades, there has been a clear shift from being self-employed [or joining a small physician-owned group] to being employed by a hospital system," says Rick Kellerman, MD, professor and chair, Department of Family and Community Medicine, University of Kansas School of Medicine - Wichita. As a result, family medicine residency programs, including the program at University of Kansas, have modified their practice management curricula from "how to start your practice" to "how to review a contract."
The Ease of Getting an Employed Position
Due to a physician shortage, jobs are plentiful. In fact, more than 55 percent of primary-care residents received over 100 specific job solicitations during their residency training, the Merritt Hawkins survey reported. "We have never seen this category so high since we began conducting the survey in 1991," says Singleton.
"Highly sought-after residents can have an offer in their desired location fairly quickly, sometimes in as short as one month," says Jamie Thomas, executive vice president of recruiting, The Medicus Firm, a national physician search firm based in Dallas, Texas.
Unlike their Gen X predecessors who were more focused on how much money they could garner as physicians, today's younger physicians are more concerned about their vacation packages. "Work/life balance is an even a bigger motivator than financial compensation today," Thomas says. In a hospital-employed practice, he says physicians are more likely to work 8 a.m. to 5 p.m.
The Other Side of the Coin
Although many say that an employed position offers more work-life balance than being a practice owner, it depends upon whom you ask. Emily Briggs, MD, family physician, Briggs Family Medicine, New Braunfels, Texas, who started a private practice right out of residency, says autonomy and being able to set her own schedule was key in her decision. "When I started my practice, my children had extra-curricular activities on Wednesday afternoons. I didn't schedule office hours during that time so I could attend," she says. "If I worked for a large group or hospital, scheduling flexibility might not be available."