It was a typical Monday morning. The executive team, eight VPs and the CEO, met every Monday morning at 8:00 a.m. for administrative council. The only one missing at 8:00 a.m. that morning was the CEO.
In a moment the door opened and a fairly stern-faced CEO walked deliberately to the head of the table and dropped his stack of files. As they hit the table top she extolled, “Any doctor can have your job any day. Never forget that.”
Well, enough for “good morning.” Our meeting proceeded in a very orderly and efficient fashion and we found ourselves back in our offices more quickly than usual. None of us ever knew that prompted that CEO Policy statement. But, we all knew it involved some vocal member of the medical staff in an encounter during the CEO’s regular morning rounds.
Frankly, in the 1980’s, it wasn’t really a statement that needed to be made. We all knew it – we just didn’t like hearing it. But that was life then. Physicians did rule healthcare, most hospitals were nonprofit enterprises and insurance companies were struggling with usual and customary payments to physicians.
Prospective payment was in effect for hospitals, but not for physicians, so physicians still played golf on Wednesday or Thursday afternoon (some both) and luxury cars filled the doctors’ parking lot. We had black tie dinners and lunch at the club was normal.
WOW – what happened?
Today, insurance companies rule healthcare and hospital systems run eagerly behind them trying to pick up the payment scraps left behind. Doctors don’t even play golf anymore and Honda’s and Toyota’s fill the physicians’ parking lot – if there is one. Sure, there are exceptions, but for the most part, physicians are struggling just to keep their feet on the bottom rung.
I tracked physicians’ incomes between 1990 and 2010 using Internal Medicine as my benchmark, or Canary in the Coal Mine, income barometer. During that 20-year period IM’s showed about a one (1%) percent annual increase. Insurance and hospital executives, during the same period showed eight to 12 percent increases – I tracked executive income too.
In 1990 a successful hospital executive made about as much as a primary care (IM) physician and a hospital “system” CEO would make two to three times that. Run the numbers, and today you’ll see the small to medium hospital CEO is now two to four times the IM and the “system” CEO is five to seven, eight, nine, even 10 times the IM. Look for yourself. A website called http://www.guidestar.org publishes the IRS 990 forms for many nonprofit organizations. Your hospital may be listed. The IRS 990 lists the highest paid executives for the organization. See how you and yours stack up.
But, what else has happened. Today, doctor, any staff member in the hospital can have YOUR job if they want it. All they need to do is say you were intimidating, unfriendly, threatening, brusque, or perhaps overly-friendly, suggestive… pick your word, and it can be used against you. What happens next? You may be forced into counseling, you may see restrictions on your practice, you may be terminated. And those actions, many of them, become a part of your permanent record – to follow you for the rest of your career.
What’s the answer… the answer is “that ship has sailed.” I often recount a somewhat composite example of events in the early ‘80’s when insurance companies called physicians and in light of prospective payment invited them to sit down and discuss working together. Typically, those physicians eagerly agreed – “take me to dinner tonight or meet me for an early breakfast (very early) in the morning.” That seemed a bit of a hassle to those insurance execs’. So, they called me. And I said, of course I’d like to meet, lunch or how about golf? Lunch and golf won out. Add to that, most physicians were independent, small groups or solo… that meant hundreds of breakfast and/or dinner meetings. With the hospital, it was one person, one meeting and the deal was done.
Will it change? Yes, simply because everything changes. We are today experiencing a feeding frenzy in practice acquisition and consolidation. Guess what, we had the same thing in the late ’80 and early 1990’s. By the late ‘90’s and early 2000’s the frenzy was to sell-off those practices. I know, I was there.
But other factors are at play today. Physician expectations are changing. Generationally, I see the 35-42 year olds as a group mostly comfortable with employment models. The 42-55 year olds are mostly suffering considerable angst. You might call them the Physician Sandwich Generation, pulled between employment and independence and then the 55+ physicians who mostly just want to be able to get out of practice. The stock market plunges of the past decade have taken away many comfortable retirements, so those physicians are either struggling to restart careers or jobs outside practice or tighten their belts and wade through the practice muck for another ten years with the hope of a later retirement.
Practice can change, but it will be changed from the top down and physicians are not usually sitting in the top organizational seats. And, that needs to change.
Nonclinical career opportunities for physicians abound. Physicians represent a great untapped intellectual resource with applicability to all areas of healthcare, healthcare related fields (think healthcare architecture, for example) and completely unrelated industries. If you’ve read previous posts from me, you know I define physicians as the “great problem solvers.” So any field where a physician has interest, passion and knowledge coupled with a desire to solve their problems, is a good fit.
The time is now to redefine yourself before someone else, someone with far less knowledge and education and with very different objectives decides to do it for you.