Tuesday, June 15, 2010

Second of Four Parts. Interview with Lori Schutte, President of Cjeka Search, Inc, a National Physician Recruiting Firm.

The Importance of the Presence of EHRs and Hospitalists as Recruiting Draws for Young Physicians, Their Indifference to Reform, Practice Acquisitions by Large Entities, and Need for Practice Flexibility.

Preface: I conducted this interview on behalf of The Physicians Foundation, a nonprofit charitable organization representing physicians in state medical societies. Most of these physicians are in independent, physicians-owned practices. The Foundation is interested in what attracts physicians to new practices, why and when they leave these practices after being recruited, what characteristics organizations employing physicians are looking for, and how the physician practice landscape is changing.
Q: From my vantage point, a couple of things surprised me about survey on physician recruiting and retention.. One was that it was important for young physicians being recruiting that the group they joined have an electronic medical record platform. That surprised me perhaps because I have been talking to older physicians who are much more skeptical about electronic medical records. Yet that is one of the top issues for young doctors.

A: Yes, that’s because young doctors are very technologically savvy. Having EMRs says something about the organization. They want to be with someone that is on the cutting edge. And it plays to their strengths.

Q: The other thing that surprised me was the muted response to reform issues. In my world, there is genuine alarm about the implications of reform and how it will negatively impact the practice of medicine. In your survey, there was more uncertainty, but not alarm about reform. Do I read that correctly?

A: I think you read it correctly. They know issues are looming but they don’t know the impact on organizations they may be joining.

Q: On reform, they seemed to be most interested in whether reform would provide bonuses to primary care doctors.

A: This survey was conducted in the fall of 2009, fairly early in the reform process, so it may be the issues were not well-defined at that point. Another issue was the future of Medical Homes, which to this day remains unknown.

Q: As I read your survey, another question sprang to mind. From various sources, I keep hearing hospitals are acquiring primary care and specialty groups at an accelerating rate. But I gather from your MGMA constituency, which consists mostly of medium and large sized multispecialty groups, this may not be the case.

A: Well, groups are interested in expanding their reach by acquiring existing practices. The groups are getting bigger. I think both hospital-based and independent groups are growing. Consolidation is occurring because there is a distinct competitive advantage in being larger and acquiring existing practices is the easiest way to grow.

Q: That would indicate to me that integrated delivery systems are likely to grow.

A: Yes, I think in many communities you will see hospitals partnering with medical groups in order to grow. In many instances, many of those smaller groups are going to the big groups and hospitals and saying, we want to be acquired. We want to work for you because it minimizes our risks. They want to on salary with a guaranteed income.

Q: In titling this interview, I thought of calling it, “The Political Transformation of American Medicine, the Making of a Vast Industry,’ after Paul Starr’s 1982 book, “The Social Transformation of American Medicine, The Making of a Vast Industry.” It seems to me what’s happening is a vast consolidation of American Medicine to meet the uncertainties over the next 4 to 10 years.

A: Yes, and in addition, there are other undisputed facts. What physicians want is flexibility and life style practices. This is reflected in our data showing the desire for part-time practices going from 13 percent to 21 percent. One of our recommendations to the membership was: be prepared to address the part-time issue. Don’t be rigid with fixed work hours and you will have to work every third weekend.

Q: I notice in your survey, you split doctors into three groups: early career, mid-career, and late career. As physicians approach late career, this need for flexibility grows.

A: Yes, and this is particularly true for male physicians. In early careers, it’s females who want more flexibility. We surmise for females that are because of family issues.

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