Hospitals are hiring more physicians

By Harry Wessel | Sentinel Staff Writer

http://www.orlandosentinel.com

With his 3-year-old, A.J., in tow and month-old twins at home, Florida Hospital surgeon Dr. Alric Simmonds takes a timeout at work to sing the praises of hospital employment.

“It’s not that the hours are less — you’re on call, you carry a pager, you’re accessible. But business decisions, the red-tape wrangling, are something you don’t have to worry about,” said Simmonds, 38, who became a full-time Florida Hospital employee in August.

A surgeon and faculty member for the hospital’s surgical-residency program, Simmonds is also a full-time dad who wants to spend as much time as possible with his family, not deal with “the stuff that jades you and takes you away from your practice.”

His colleague, Dr. Rhonda Harmon, who joined the Florida Hospital staff five months ago, said being a hired hand means she can spend more quality time with her 19-month-old daughter.

“I don’t have to worry about office management. When you’re home, you’re home,” said Harmon, 37, who is also a surgeon and faculty member.

A third member of the hospital’s six-doctor surgical group, Dr. Jean Fung, 31, put it succinctly: “We’re not businessmen or businesswomen.”

While there’s nothing radical about a hospital hiring doctors, the conventional model has been for doctors to work at hospitals as independent practitioners who choose to admit their patients there.

Historically, the vast majority of doctors walking hospital halls in the U.S. worked in the private sector, in solo or group practices. Hospitals provided a place where those doctors could take care of their patients in an acute-care environment. It was a symbiotic, rather than an employer-employee, relationship.

But that is changing. “An increasing number of hospitals are employing physicians,” concluded a survey released this summer by Merritt Hawkins & Associates, a Texas-based physician search and consulting company.

From 2004 to 2007, the company said, its physician-search assignments more than doubled — from 19 percent of its searches to 43 percent.

While there are a number of reasons for such a nationwide trend, the biggest is that “physicians are sick of the business of medicine,” said Merritt Hawkins spokesman Travis Singleton. Rather than worrying about paperwork, insurance, malpractice and other bottom-line concerns, “younger physicians just want to see patients and practice medicine.”

Older physicians with successful practices may not be interested in hospital employment, but younger physicians are more “quality-of-life oriented,” Singleton said, more interested in a work-life balance than the prospect of huge earnings.

The trend is even more pronounced in Florida, which has the fewest doctors per 100,000 residents of any large state, a higher-than-average percentage of elderly people, and a higher-than-average percentage of older doctors.

Forty-four percent of licensed Florida doctors, compared with 36 percent of licensed doctors nationwide, are over age 55, according to the Florida Hospital Association.

Older doctors will eventually need to be replaced by younger ones, and there aren’t enough to go around. But hospitals charged with providing a full range of medical services have to find them somehow, and full-time employment is a way to do it.

More than nine of every 10 surveyed hospitals in Florida plan to employ more physicians in the next five years, according to Kim Streit, vice president for health-care research and information with the Florida Hospital Association.

The most common physician specialties that hospitals will be seeking: internal medicine, orthopedics, general surgery and family practice, Streit said.

Florida Hospital’s staff of employee doctors has jumped from 80 to 124 during the past five years — a 55 percent increase — while Orlando Regional Healthcare’s staff of doctors has doubled from 60 to 120 since 2004.

The “historic mutual dependence” between hospitals and physicians has been broken, said Dr. Timothy Bullard, Orlando Regional’s chief medical officer. With the increasing popularity and sophistication of outpatient facilities, many specialists no longer need the hospital to practice their craft, he said. That means hospitals either have to hire individuals or contract with medical groups to offer certain services.

Two prime examples are emergency-room physicians and “hospitalists,” Bullard said. In years past, he said, doctors in the surrounding community would take shifts in emergency rooms, and primary-care specialists would occasionally leave their offices to make rounds at the hospital.

Now there are board-certified emergency-room specialists and hospitalists who specialize in coordinating such care for hospitalized patients. These specialists are not necessarily hospital employees; both Florida Hospital and Orlando Regional contract with outside groups that provide them with emergency-room specialists and hospitalists. But their presence means doctors in private practice have less connection to hospitals.

Besides, said Bullard, things have gotten so specialized that many physicians “are no longer in the position to feel comfortable to take care of things coming into the hospital. You end up having to hire those people.”

Dr. David Moorhead, Bullard’s counterpart at Florida Hospital, notes that both his institution and Orlando Regional continue to rely on a combination of employed, contracted and independent physicians.

Florida Hospital’s plans to develop a top-notch liver-transplant program, for example, could not happen without employed specialists. To get world-class liver surgeons and specialists, you need to provide “an environment where they know the hospital is committed to it and will spend money,” Moorhead said.

“On the other hand, the fabric of Florida Hospital and Orlando Regional would cease without the services of private physicians,” he said. “The trick [for hospitals] is to serve both constituencies.”

One of the most aggressive hospitals in the state when it comes to employed physicians is Lee Memorial in Fort Myers. Hospitals that don’t hire doctors now will be under increasing pressure to do so, said Dr. C.B. Rebsamen, chief medical officer of ambulatory and strategic services for that health system.

Hospitals by law have to provide access to those who need their services, and, with a growing shortage of primary-care specialists, hospitals will be forced to hire them to continue to provide access.

“Ten or 15 years ago, 50 percent of medical-school graduates went into primary-care medicine,” Rebsamen said. “Now it’s only about one-third.”

And those who choose specialties, such as Florida Hospital’s newly hired Alric Simmonds, are increasingly likely to choose hospital employment. He recently returned from a medical conference, where he talked with some of his young peers who had gone into private practice. “They talked about being tired and being worried about billing. Here, I can concentrate on taking care of patients.”
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