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The health care workforce is being transformed by profound demographic changes and the steady growth of the U.S. health sector. In addition, the movement of physicians out of private practice to employment by medical centers has accelerated. And a new generation of health care professionals is demanding a sustainable work/life balance. These trends will combine to change the work environment of chest physicians.
Spending
The United States spends about twice as much on health care as any other industrialized nation and this fact is driving an increasingly urgent public discussion about options and means of reducing costs.1 Medicare and Medicaid already account for about a quarter of federal government spending and those numbers are expected to rise as baby boomers age.1 Employer spending on health care as a percentage of wages has doubled since the 1980s.2
Workforce supply
An expanding health care sector means a growing demand for health care labor. Health care occupations are projected to grow 18% from 2016 to 2026, faster than the average for all occupations and adding 2.4 million new jobs to the economy.3 Expert testimony before the U.S. Senate Committee on Health, Education, Labor, and Pensions in May 2018 projected shortages of physicians in the coming years. According to estimates of the Health Resources and Services Administration (HRSA), there is a need for 13,800 additional primary care physicians in areas – especially rural – that are designated as health professional shortage areas. Signs of a worsening situation include projected shortages of 20,000 primary care physicians by 2025, according to HRSA, and 42,600-121,300 physicians by 2030, according to the Association of American Medical Colleges. The demand for physicians will exceed supply by 46,000-90,000 by 2025. An update to that research increased the projected shortage range to 61,700-94,700 by 2025.4 These shortages will result in recruiting challenges for many medical centers, especially those in rural areas.
Employment
Private practice is becoming the less common structure of employment for physicians. According to American Medical Association data, physician ownership of practices dropped below 50% for the first time in 2016.5 The trend toward employed versus private practice physicians is expected to continue. The size of practices is growing, with about one-third of physicians working in a hospital-owned practice or employed directly by a hospital and around 40% in practices of 10 physicians or more.5 Of every 10 physician practices, 3 were hospital owned in 2016.6 Physicians are being called upon to do more data entry and administrative work; 21% of physicians’ time is now spent on nonclinical paperwork.7 The ripple-out effects of what amounts to a seismic shift in the work structure and work environment for physicians are only beginning to be studied in terms of overall personal satisfaction and impact on patient care.
Stephanie M. Levine, MD, FCCP, the designate president of the American College of Chest Physicians and professor of medicine in the division of pulmonary diseases and critical care medicine at the University of Texas, San Antonio, recognizes the significance of the move from private practice to employment and suggests that advantages could be offset by some potential negatives practicing chest physicians. She noted, “Pros include potentially more job security, more predictable work hours, perhaps a reduction in some of the traditional administrative ‘hassles’ with running a private practice, and possibly a better and healthier work/life balance. Some think that physician input and leadership in the employed model may have more influence on a health care system than in an individual private practice. Nonclinical work may be decreased, but it is not clear that this is true.
“The negatives include a loss of autonomy, a potential loss of personal ownership of our patients’ health, and the loss of a unique personal culture of private practice. Physicians may be subject to metrics imposed by the employer. In addition, we may see more job turnover since physicians could be less invested emotionally and financially; fewer patients seen since the structure is often salary based and not based on productivity; and increased shift work, set work hours, and schedules. Thus, the employer-based model may actually contribute to the ongoing physician shortage.”
Dr. Levine stressed the role of training programs to prepare physicians for what may lie ahead. “Training programs must prepare physicians for what to expect as employees.”
Changing expectations
An evolution of expectations about a healthy work/life balance has occurred in many professions, including the health care profession. While younger practitioners may be more likely to embrace the changes occurring within health care, they are often more vocal about their desire for a healthy work/life balance and may be less likely to spend time away from family and friends rather than completing administrative tasks. Parenting is increasingly regarded by women and men as compatible with a full and rewarding career as a physician. So these changing expectations about work/life balances mean health care institutions will have to adjust their own expectations in order to recruit and maintain top-quality staff.
Stress and burnout
Workforce shortages, overwhelming administrative tasks, and a variety of forces that come with employment in a large medical system are causing stress and burnout in many physicians. In a 2018 Medscape study of more than 15,000 physicians, 42% reported burnout, and 15% admitted to experiencing either clinical or colloquial forms of depression.8 Dr. Levine acknowledges that many chest physicians are at risk for burnout. “In our field of medicine, particularly with those that practice in an intensive care setting, we are faced with the high stress and emotional experiences we encounter in the life and death nature of our jobs. We care for the sickest patient population, and are often facing life and death clinical needs as well as end-of-life discussions and care. Burnout is a potential threat to both patient safety and the quality of healthcare that we practice.”
Dr. Levine strongly urges colleagues to remain vigilant to this potentially devastating condition in their fellow physicians and in themselves. She said, “If you suspect you are feeling the symptoms of burnout, or have been told so by a colleague, then talk to a peer or colleague, take personal time to do something you enjoy, and/or join a support group. But better than that, try to preempt burnout by developing a strong emotional peer support group in or out of work, practicing mindfulness training, and paying attention to wellness and self-care.”
Burnout is finally being recognized by medical institutions as a significant factor in physician health and performance, and in the recruitment and attrition of staff. Dr. Levine sees progress in how health care institutions deal with burnout, wellness, and work/life balance among staff and trainees. In a hopeful note, Dr. Levine suggested that institutional responses to burnout and the workplace factors that fuel burnout may improve work conditions for physicians in the future.
These trends in the U.S. economy and workforce will mean a steady growth of the health care sector for the foreseeable future, continued political and social pressure to control costs, fewer physicians in private practice, and a potential move away from unhealthy work/life ratios currently so common among physicians.
Dr. Levine concluded that it is up to training programs to prepare trainees for these sea changes to the practice of medicine.
References
1. https://www.healthleadersmedia.com/finance/healthcare-spending-20-gdp-thats-economy-wide-problem
2. PwC Health Research Institute
3. https://www.bls.gov/ooh/healthcare/home.htm
4. https://www.hfma.org/Content.aspx?id=60811
5. https://www.ama-assn.org/about-ama/research/physician-practice-benchmark-survey
6. http://www.physiciansadvocacyinstitute.org/
7. https://omahamedical.com/wp-content/uploads/2016/12/2016-Survey-of-Americas-Physicians-Practice-Patterns-and-Perspectives.pdf
8. https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235
The health care workforce is being transformed by profound demographic changes and the steady growth of the U.S. health sector. In addition, the movement of physicians out of private practice to employment by medical centers has accelerated. And a new generation of health care professionals is demanding a sustainable work/life balance. These trends will combine to change the work environment of chest physicians.
Spending
The United States spends about twice as much on health care as any other industrialized nation and this fact is driving an increasingly urgent public discussion about options and means of reducing costs.1 Medicare and Medicaid already account for about a quarter of federal government spending and those numbers are expected to rise as baby boomers age.1 Employer spending on health care as a percentage of wages has doubled since the 1980s.2
Workforce supply
An expanding health care sector means a growing demand for health care labor. Health care occupations are projected to grow 18% from 2016 to 2026, faster than the average for all occupations and adding 2.4 million new jobs to the economy.3 Expert testimony before the U.S. Senate Committee on Health, Education, Labor, and Pensions in May 2018 projected shortages of physicians in the coming years. According to estimates of the Health Resources and Services Administration (HRSA), there is a need for 13,800 additional primary care physicians in areas – especially rural – that are designated as health professional shortage areas. Signs of a worsening situation include projected shortages of 20,000 primary care physicians by 2025, according to HRSA, and 42,600-121,300 physicians by 2030, according to the Association of American Medical Colleges. The demand for physicians will exceed supply by 46,000-90,000 by 2025. An update to that research increased the projected shortage range to 61,700-94,700 by 2025.4 These shortages will result in recruiting challenges for many medical centers, especially those in rural areas.
Employment
Private practice is becoming the less common structure of employment for physicians. According to American Medical Association data, physician ownership of practices dropped below 50% for the first time in 2016.5 The trend toward employed versus private practice physicians is expected to continue. The size of practices is growing, with about one-third of physicians working in a hospital-owned practice or employed directly by a hospital and around 40% in practices of 10 physicians or more.5 Of every 10 physician practices, 3 were hospital owned in 2016.6 Physicians are being called upon to do more data entry and administrative work; 21% of physicians’ time is now spent on nonclinical paperwork.7 The ripple-out effects of what amounts to a seismic shift in the work structure and work environment for physicians are only beginning to be studied in terms of overall personal satisfaction and impact on patient care.
Stephanie M. Levine, MD, FCCP, the designate president of the American College of Chest Physicians and professor of medicine in the division of pulmonary diseases and critical care medicine at the University of Texas, San Antonio, recognizes the significance of the move from private practice to employment and suggests that advantages could be offset by some potential negatives practicing chest physicians. She noted, “Pros include potentially more job security, more predictable work hours, perhaps a reduction in some of the traditional administrative ‘hassles’ with running a private practice, and possibly a better and healthier work/life balance. Some think that physician input and leadership in the employed model may have more influence on a health care system than in an individual private practice. Nonclinical work may be decreased, but it is not clear that this is true.
“The negatives include a loss of autonomy, a potential loss of personal ownership of our patients’ health, and the loss of a unique personal culture of private practice. Physicians may be subject to metrics imposed by the employer. In addition, we may see more job turnover since physicians could be less invested emotionally and financially; fewer patients seen since the structure is often salary based and not based on productivity; and increased shift work, set work hours, and schedules. Thus, the employer-based model may actually contribute to the ongoing physician shortage.”
Dr. Levine stressed the role of training programs to prepare physicians for what may lie ahead. “Training programs must prepare physicians for what to expect as employees.”
Changing expectations
An evolution of expectations about a healthy work/life balance has occurred in many professions, including the health care profession. While younger practitioners may be more likely to embrace the changes occurring within health care, they are often more vocal about their desire for a healthy work/life balance and may be less likely to spend time away from family and friends rather than completing administrative tasks. Parenting is increasingly regarded by women and men as compatible with a full and rewarding career as a physician. So these changing expectations about work/life balances mean health care institutions will have to adjust their own expectations in order to recruit and maintain top-quality staff.
Stress and burnout
Workforce shortages, overwhelming administrative tasks, and a variety of forces that come with employment in a large medical system are causing stress and burnout in many physicians. In a 2018 Medscape study of more than 15,000 physicians, 42% reported burnout, and 15% admitted to experiencing either clinical or colloquial forms of depression.8 Dr. Levine acknowledges that many chest physicians are at risk for burnout. “In our field of medicine, particularly with those that practice in an intensive care setting, we are faced with the high stress and emotional experiences we encounter in the life and death nature of our jobs. We care for the sickest patient population, and are often facing life and death clinical needs as well as end-of-life discussions and care. Burnout is a potential threat to both patient safety and the quality of healthcare that we practice.”
Dr. Levine strongly urges colleagues to remain vigilant to this potentially devastating condition in their fellow physicians and in themselves. She said, “If you suspect you are feeling the symptoms of burnout, or have been told so by a colleague, then talk to a peer or colleague, take personal time to do something you enjoy, and/or join a support group. But better than that, try to preempt burnout by developing a strong emotional peer support group in or out of work, practicing mindfulness training, and paying attention to wellness and self-care.”
Burnout is finally being recognized by medical institutions as a significant factor in physician health and performance, and in the recruitment and attrition of staff. Dr. Levine sees progress in how health care institutions deal with burnout, wellness, and work/life balance among staff and trainees. In a hopeful note, Dr. Levine suggested that institutional responses to burnout and the workplace factors that fuel burnout may improve work conditions for physicians in the future.
These trends in the U.S. economy and workforce will mean a steady growth of the health care sector for the foreseeable future, continued political and social pressure to control costs, fewer physicians in private practice, and a potential move away from unhealthy work/life ratios currently so common among physicians.
Dr. Levine concluded that it is up to training programs to prepare trainees for these sea changes to the practice of medicine.
References
1. https://www.healthleadersmedia.com/finance/healthcare-spending-20-gdp-thats-economy-wide-problem
2. PwC Health Research Institute
3. https://www.bls.gov/ooh/healthcare/home.htm
4. https://www.hfma.org/Content.aspx?id=60811
5. https://www.ama-assn.org/about-ama/research/physician-practice-benchmark-survey
6. http://www.physiciansadvocacyinstitute.org/
7. https://omahamedical.com/wp-content/uploads/2016/12/2016-Survey-of-Americas-Physicians-Practice-Patterns-and-Perspectives.pdf
8. https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235
The health care workforce is being transformed by profound demographic changes and the steady growth of the U.S. health sector. In addition, the movement of physicians out of private practice to employment by medical centers has accelerated. And a new generation of health care professionals is demanding a sustainable work/life balance. These trends will combine to change the work environment of chest physicians.
Spending
The United States spends about twice as much on health care as any other industrialized nation and this fact is driving an increasingly urgent public discussion about options and means of reducing costs.1 Medicare and Medicaid already account for about a quarter of federal government spending and those numbers are expected to rise as baby boomers age.1 Employer spending on health care as a percentage of wages has doubled since the 1980s.2
Workforce supply
An expanding health care sector means a growing demand for health care labor. Health care occupations are projected to grow 18% from 2016 to 2026, faster than the average for all occupations and adding 2.4 million new jobs to the economy.3 Expert testimony before the U.S. Senate Committee on Health, Education, Labor, and Pensions in May 2018 projected shortages of physicians in the coming years. According to estimates of the Health Resources and Services Administration (HRSA), there is a need for 13,800 additional primary care physicians in areas – especially rural – that are designated as health professional shortage areas. Signs of a worsening situation include projected shortages of 20,000 primary care physicians by 2025, according to HRSA, and 42,600-121,300 physicians by 2030, according to the Association of American Medical Colleges. The demand for physicians will exceed supply by 46,000-90,000 by 2025. An update to that research increased the projected shortage range to 61,700-94,700 by 2025.4 These shortages will result in recruiting challenges for many medical centers, especially those in rural areas.
Employment
Private practice is becoming the less common structure of employment for physicians. According to American Medical Association data, physician ownership of practices dropped below 50% for the first time in 2016.5 The trend toward employed versus private practice physicians is expected to continue. The size of practices is growing, with about one-third of physicians working in a hospital-owned practice or employed directly by a hospital and around 40% in practices of 10 physicians or more.5 Of every 10 physician practices, 3 were hospital owned in 2016.6 Physicians are being called upon to do more data entry and administrative work; 21% of physicians’ time is now spent on nonclinical paperwork.7 The ripple-out effects of what amounts to a seismic shift in the work structure and work environment for physicians are only beginning to be studied in terms of overall personal satisfaction and impact on patient care.
Stephanie M. Levine, MD, FCCP, the designate president of the American College of Chest Physicians and professor of medicine in the division of pulmonary diseases and critical care medicine at the University of Texas, San Antonio, recognizes the significance of the move from private practice to employment and suggests that advantages could be offset by some potential negatives practicing chest physicians. She noted, “Pros include potentially more job security, more predictable work hours, perhaps a reduction in some of the traditional administrative ‘hassles’ with running a private practice, and possibly a better and healthier work/life balance. Some think that physician input and leadership in the employed model may have more influence on a health care system than in an individual private practice. Nonclinical work may be decreased, but it is not clear that this is true.
“The negatives include a loss of autonomy, a potential loss of personal ownership of our patients’ health, and the loss of a unique personal culture of private practice. Physicians may be subject to metrics imposed by the employer. In addition, we may see more job turnover since physicians could be less invested emotionally and financially; fewer patients seen since the structure is often salary based and not based on productivity; and increased shift work, set work hours, and schedules. Thus, the employer-based model may actually contribute to the ongoing physician shortage.”
Dr. Levine stressed the role of training programs to prepare physicians for what may lie ahead. “Training programs must prepare physicians for what to expect as employees.”
Changing expectations
An evolution of expectations about a healthy work/life balance has occurred in many professions, including the health care profession. While younger practitioners may be more likely to embrace the changes occurring within health care, they are often more vocal about their desire for a healthy work/life balance and may be less likely to spend time away from family and friends rather than completing administrative tasks. Parenting is increasingly regarded by women and men as compatible with a full and rewarding career as a physician. So these changing expectations about work/life balances mean health care institutions will have to adjust their own expectations in order to recruit and maintain top-quality staff.
Stress and burnout
Workforce shortages, overwhelming administrative tasks, and a variety of forces that come with employment in a large medical system are causing stress and burnout in many physicians. In a 2018 Medscape study of more than 15,000 physicians, 42% reported burnout, and 15% admitted to experiencing either clinical or colloquial forms of depression.8 Dr. Levine acknowledges that many chest physicians are at risk for burnout. “In our field of medicine, particularly with those that practice in an intensive care setting, we are faced with the high stress and emotional experiences we encounter in the life and death nature of our jobs. We care for the sickest patient population, and are often facing life and death clinical needs as well as end-of-life discussions and care. Burnout is a potential threat to both patient safety and the quality of healthcare that we practice.”
Dr. Levine strongly urges colleagues to remain vigilant to this potentially devastating condition in their fellow physicians and in themselves. She said, “If you suspect you are feeling the symptoms of burnout, or have been told so by a colleague, then talk to a peer or colleague, take personal time to do something you enjoy, and/or join a support group. But better than that, try to preempt burnout by developing a strong emotional peer support group in or out of work, practicing mindfulness training, and paying attention to wellness and self-care.”
Burnout is finally being recognized by medical institutions as a significant factor in physician health and performance, and in the recruitment and attrition of staff. Dr. Levine sees progress in how health care institutions deal with burnout, wellness, and work/life balance among staff and trainees. In a hopeful note, Dr. Levine suggested that institutional responses to burnout and the workplace factors that fuel burnout may improve work conditions for physicians in the future.
These trends in the U.S. economy and workforce will mean a steady growth of the health care sector for the foreseeable future, continued political and social pressure to control costs, fewer physicians in private practice, and a potential move away from unhealthy work/life ratios currently so common among physicians.
Dr. Levine concluded that it is up to training programs to prepare trainees for these sea changes to the practice of medicine.
References
1. https://www.healthleadersmedia.com/finance/healthcare-spending-20-gdp-thats-economy-wide-problem
2. PwC Health Research Institute
3. https://www.bls.gov/ooh/healthcare/home.htm
4. https://www.hfma.org/Content.aspx?id=60811
5. https://www.ama-assn.org/about-ama/research/physician-practice-benchmark-survey
6. http://www.physiciansadvocacyinstitute.org/
7. https://omahamedical.com/wp-content/uploads/2016/12/2016-Survey-of-Americas-Physicians-Practice-Patterns-and-Perspectives.pdf
8. https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235