Culture change for hospital-employed docs used to private practices

Culture clashes may lead to turnover

Writing in Modern Healthcare last week, Melanie Evans explains the cultural tensions at hospitals that have hired doctors from private practices who struggle to leave behind their independent and autonomous culture.

Six years ago, only 16% of physicians were hospital employees. In 2012, 20% worked for a hospital, according to the American Medical Association (AMA). The increase can be attributed to new payment models necessitating closer collaboration between providers and hospitals, Evans writes.

As hospitals ramp up hiring, one in two doctors remains self-employed

The shift has also coincided with a changing attitude among young physicians, who tend to value work-life balance and career satisfaction. Moreover, one-third of current physicians are women—compared to just one-fifth in the mid-1980s—and female doctors are two times more likely than men to work part-time, according to the latest American Medical Group Association (AMGA) survey.

"When they're coming out of the gates now, they want to both work and play… they don't want to build a practice," says David Richards, executive director of the medical group at Excela Health. Younger doctors also may not be looking to take on leadership roles or other responsibilities that lengthen the work day, physician recruiters say.

At the same time, older doctors who come from a private practice setting think of themselves as small business owners. Physicians from private practices are "used to setting the rules….one of the things you give up is that complete independence," says T. Clifford Deveny, Catholic Health Initiatives' senior vice president for physician services and clinical integration.  

Culture clash: Age, values drive gap

When these two groups of physicians become co-workers, they may clash over sharing the workload and respond differently to hospital-wide initiatives, Evans writes.

According to physician recruiters, newer medical school graduates are often better in team-based care settings, as well environments that prioritize electronic health records, social media, and other information technology facets. Meanwhile, doctors coming from leadership roles in private practices are valuable to hospitals because leaders will become more important as new delivery models proliferate, such as ACOs, according to Baptist Health's CCO Timothy Jahn.

The cultural discord can lead to costly turnover, Evans writes. Culture conflict is among the top five reasons physicians leave hospitals and physician turnover grew from 6.1% in 2010 to 6.8% in 2012, according to the AMGA survey.

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"Turnover is terrible for everybody," says Les Mathers, senior vice president for physician recruitment at OSF HealthCare. The best way to prevent such turnover is to illustrate the culture and expectations of the hospital before physicians agree to become employees, says Mathers, adding that it is "most important is to try to make sure that expectations are clear on both sides" (Evans, Modern Healthcare, 2/8 [subscription required]).

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