Have you ever felt stuck in your medical career? Have you considered backing away or quitting?
There has been a growing trend that practitioners are looking to leave clinical medicine altogether, especially physicians. But why? Are they all overworked? Does the system burn them out? What is the source and cause for so many physicians attempting to leave clinical medicine?
Physicians are looking for alternative careers rather than the traditional practice of medicine. Some are leaving their work at clinics and hospitals to become telemedicine providers or to work at wellness spas. Others are leaving clinical medicine altogether for full-time non-clinical roles to become utilization reviewers, medico-legal consultants, work in pharmaceuticals, and become life coaches. Don’t forget the physicians that have left medicine to become entrepreneurs, manage businesses outside of healthcare, and become real estate moguls.
One must ask, are physicians leaving medicine because corporate medicine is too much for them? Are physicians experiencing brunout, or have they found the practice of medicine unfulfilling? There are so many reasons why physicians might want to quit clinical medicine. The healthcare system is built to wear down any reasonable individual, with high workloads and long hours. The medical profession becomes a constant battle for physicians as they struggle with the amount of required documentation, lack of reimbursement, patient volume, and unrealistic patient expectations.
So how do we deal with this problem of so many physicians leaving medicine? Everyone in the medical community has their own theories of why physicians are leaving medicine. Many solutions have been offered, yet we continue to hear of a physician shortage. This article proposes one theory for why physicians are leaving medicine and one possible solution to keep physicians from altogether leaving clinical medicine.
To better identify why physicians leave clinical medicine, performing a “root cause analysis” is best. In the world of engineering, a root cause analysis is performed to identify the source of a known problem. A root cause analysis might be performed if an automobile manufacturer starts to see defective parts coming off an assembly line or to understand why a website is not processing a purchasing order. To perform a root cause analysis, engineers behave like detectives to investigate the source of a problem and then provide possible solutions. Engineers can offer simple, cost-effective solutions that provide long-term savings based on their investigative work involving interviews, research, testing, and analysis.
In medicine, the problem is apparent: too many physicians are leaving clinical medicine, which could alter how medicine is practiced. An engineer performing a root cause analysis might look at this problem differently than a healthcare expert. An engineer could design a case study where the hospital represents an automobile manufacturing plant, and the assembly line is the entire process of caring for patients from ailment to recovery. Like the hospital, it takes people to run the assembly line. Doctors and nurses treat patients, whereas assembly line workers and tradespeople build cars. Physicians are like tradespeople, skilled individuals required to keep the assembly line going. A physician shortage is analogous to a manufacturing plant with a shortage of tradespeople.
What would an engineer do if they began to see tradespeople leaving the manufacturing plants? How would the automobiles get built? This would be analogous to our current situation of physicians leaving medicine. How would patients get treated? A root cause analysis would start with determining why the tradespeople or physicians were leaving. It could be due to pay, a feeling of being overworked, and many other reasons. In this case study, an engineer may conclude that these professionals are leaving their work due to a sense of being overworked and that they simply want more time off.
Now that an engineer has determined the cause of physicians leaving, they must offer validated solutions. In this case, the engineer researches new hiring practices, using locums companies, contracting with private groups, and creating unique arrangements with physicians. After an extensive analysis, the engineer states that the most cost-effective maneuver for hospitals to combat physician shortage and deal with the volume of patients is to create unique working arrangements with existing staff and like-minded physicians. The engineer proposes that the facility consider the practice of “Fractionalized Medicine” to allow physicians to work less, get paid well, and stay in clinical medicine.
Fractionalized medicine is a term used for medical facilities contracting with physicians for non-traditional roles. Instead of facilities recruiting full-time employed physicians, they recruit physicians to set up unique arrangements that benefit both parties. Physicians are contracted to work a fraction of what would be considered a full-time role.
For example, a facility may find it difficult to hire full-time physicians, so that it may consider other arrangements such as the following:
- Physician works 7-10 days per month to provide specialty coverage to a rural area.
- Physician takes 1-2 weeks per month to help with call coverage for a solo practitioner.
- Physician takes 1-2 days per week to assist with satellite clinics.
- Physician agrees to cover call 1-2 weekends per month.
- Physician agrees to alternate every other week with another physician.
Making arrangements with physicians, as mentioned above, is a cost-effective maneuver to keep physicians happy and retain them so that facilities do not have to seek out more expensive options like privately contracted groups and locums companies. In fact, direct contracting leads to the establishment of long-term relationships. More so, facilities will not have to spend additional money recruiting new physicians when one leaves. Arranging physician schedules to have more time off to decompress and enjoy life might avoid burnout. There is a belief that if the healthcare system were to lower the volume and workload of physicians by 30%, this might eliminate burnout leading more physicians to stay in clinical medicine. In addition, it may allow more physicians to remain in medicine on limited bases as they pursue their other careers. It’s simple, provide physicians more time off to be distracted from the clinical practice of medicine that they may be less likely to leave.
Fractionalized medicine is a new concept, but it is a way to look at the hiring of physicians differently. Facilities interested in retaining physicians might consider a unique working arrangement that benefits both parties. Working a fraction of the time and having more time off may significantly improve a physician’s work-life balance. Allowing physicians to work less, and get paid well, might keep the younger generations from leaving medicine and older generations from retiring early.