Finances most likely reason for large-group doctors to seek new jobs

A survey by a physician search firm suggests that doctors working in large groups, whether independent or hospital-owned, are like their colleagues in other practice settings. They’re keeping their eyes open for better job opportunities, particularly those that provide financial stability and a more satisfying professional environment.

“In any uncertain economic climate, physicians are seeking the same thing you or I would: stability,” said Rod Arnold, CEO of Ericksson Physician Search, based in Atlanta.

The company, in conjunction with the American Medical Group Assn., surveyed 1,200 doctors working with large independent and hospital-owned groups but looking for a job change. The survey found that 57% of those looking to change practices were searching for financial security, with 52% saying they were generally dissatisfied with their current environment. (Respondents could choose more than one reason for wanting to leave.) Meanwhile, 42% cited “significant” personal lifestyle changes, such as a spousal job loss, divorce or “personal or family financial strife.”

Ericksson, which released the survey July 30, said it will do more analysis to dig deeper into the reasons behind physicians’ desire for change.

“We want to find out what is causing them angst,” Arnold said. “More and more of [physicians] are being overwhelmed by the business side. We want to find out if they are changing settings or getting out of medicine.”

Ericksson did release some information behind the numbers, including the fact that 18% of those surveyed cited student loan repayment as the major source of their financial stress. Of the 38% who said they wanted to change cities, those who wanted to move to a larger area outpaced those who wanted a less-populated location, 5 to 1.

Although hospital employment and working in a large practice setting has become more common in recent years, it may not always be as secure as it appears. Ongoing economic troubles and challenges of managing the implications of health system reform are taking their toll, industry trackers say.

For instance, a report issued July 20 by Moody’s Investors Service found that downgraded debt for nonprofit hospitals exceeded upgraded debt in the second quarter of 2012. This means these loans have become riskier and more expensive because the institution’s financial health has worsened. Other reports by the rating agency have noted that increased physician employment places a significant strain on hospital finances.

Another survey of 136 employed primary care physicians by QuantiaMD, an online physician community, released July 31 found that 49% had not had a salary increase in one to two years. The salaries of an additional 18% were cut.

“Hospitals are struggling as businesses, too, with very slim margins at best, so any employee in any business has no guarantees,” said Michael Paskavitz, editor-in-chief of QuantiaMD.

Recruiters say one strategy hospitals and other entities are using is to move away from paying physicians a straight salary and put an ever-larger proportion of compensation at risk in some way. Physicians have to hit a greater number of production or quality targets, or both.

“It’s become more of an ‘eat what you kill’ pay structure that mimics private practice,” said Tim Ketterman, senor partner in recruiting at Arthur Marshall, a physician search firm based in Irving, Texas.

Although physician recruiters say hospital employment and working for a large group is not necessarily a ticket to fiscal stability, it can ameliorate or eliminate some headaches associated with running a small practice. Recruiters say some physicians tell them they regret making the jump from small practices to other settings because of a loss of autonomy, but the other benefits often outweigh the disadvantages.

“There can be buyer’s remorse,” Ketterman said. “But when I’m working with a physician in private practice, I know I can call them in their office at seven or eight o’clock at night. They will still be in their office reviewing charts and doing payroll. The employed physicians I call on their cells, because they leave the office at 5 or 6 p.m.”