“Doctors Going Broke,” read a CNN headline on Jan. 5. Similar stories
appeared
in The New York Times and other national publications.
One cannot say that broke
is the right term for an occupation that averages in excess of $200,000 (primary
care) or more than $350,000 (specialty incomes) a year, four to seven times the
per capita national average. However, you only need be in practice to recognize
the difficulties physicians are dealing with financially.
from Nephrology News and Issues , April 2011
by Martin Osinski
These past 15 months have represented some of the most tumultuous and difficult
periods of time for physicians in practice, especially nephrologists. The
number of government and economic policy changes and their immediate impact
has never been greater. This left many practices unsure of taking the best
steps to move forward.
This article will review the various policies that have been implemented
and their impact on the average nephrology practice.
Physician shortages have been an area of concern and discussion throughout
the U.S. health care community for many years, dating back as far as the “Lee
and Jones” original needs based study of the medical workforce in 1933.1
More recently, an article appearing in the Nov. 2, 2004, issue of Annals of
Internal Medicine projected a possible shortage of 200,000 physicians in the
United States. by the year 2025.2 The U.S. Department of Labor likewise projects
that the number of health care jobs will increase almost 30% during the next
10 years. Based on these projections, the United States will add more than
three million new health care jobs by 2010.
In nephrology, the number of open positions for doctors is already double
the number of renal fellows entering practice. What will be the scenario if
this nephrologist shortage increases over the next 20 years? How will this
shortage affect the way nephrologists practice and what will be the consequences
for their patients?
Can anything be done to avert a nephrology workforce crisis?
As the demand for healthcare begins to outpace the supply of practicing physicians,
in part due to the aging population in the United States, experts predict that
the looming physician shortage will not only affect the quality of healthcare,
but in many high-demand specialties will likely have more job opportunities,
leading to retention becoming a top priority for most medical groups.
In January NN&I reported on an announcement by the Council on Graduate
Medical Education (COGME) that it is predicting a shortage of physicians in
the near future. COGME says that by 2015, an increase of 3,000 U.S. medical
graduates, a corresponding expansion in the number of resident positions, and
a change in the distribution of residency positions to more closely mirror
market demand are all needed, By 2020, there could be a shortage of 85,000
physicians, they said. In a Nov. 3, 2003, article in American Medical News,
Carl Getto, MD, Chair of COGME and Senior Vice President for Medical Affairs
for the University of Wisconsin Hospitals and Clinics, said the council’s
change in perspective was in response to mounting evidence from physician workforce
experts and physician recruitment firms. He cites trends such as younger physicians
wanting to work fewer hours, an aging population that requires more care, and
an increased demand for specialists’ services combined with less restrictive
managed care models.
These predictions for the future of health care may be on target, but my experience
to date tells a different story. If you were a nephrologist looking for a
job today, you would find the market to be tighter than it was five years
ago. The numbers of jobs out there are not as plentiful as they seemed to
have been in the recent past. Why?
Introduction
After years of hearing about having the highest mortality rate in the world,
renal care in the United States finally received some good news this year,
courtesy of the l997Annual U.S. Renal Data System Report. It appears that
the incidence rate, or new starts for patients on dialysis, is decreasing.
And, patients who are on dialysis are showing improved survival rates from
years past. Changes in the dialysis prescription-better KtlVs, hematocrits,
and longer dialysis times may be having an impact.
While the news presents a brighter picture of U.S. renal care,
it creates a dilemma for the nephrologists in charge of caring
for patients now on dialysis. The fellowship programs in this
country are not producing enough nephrologists to meet current
or future needs. There is a lack of interest among internal medicine
residents, especially those with medical school training in the
United States, to consider going into the specially. Lastly,
the supply of international medical graduates who enter nephrology
may be in jeopardy. If these three areas are not addressed shortly,
a crisis will occur for nephrologists, and even more so for the
patients who need their services.
Conducting a comprehensive search is an extensive, time-consuming process when
you are seeking a quality physician to fit your organizational goals. You
should evaluate the situation carefully. Before you initiate a search, it
is critical that you are methodical, organized and efficient since the process
takes commitment and is costly. This article will explain 10 steps to identify
quality physicians in a reasonable time frame.
One of the last stages in the physician recruitment process is presenting the
contract to the qualified candidate. This step should be a formality and
many organizations have mastered this stage. However, for some organizations
it becomes a major obstacle. If a top quality candidate is lost at this period
of the process, it becomes demoralizing. A well-designed contract can save
significant time, money and avoid massive frustrations.
