The following post comes courtesy of Vagabond MD, a radiologist who cut back who is a friend and much revered guest-poster on this blog and many others.
In it he addresses the (possibly vanishing) culture of his single-hospital democratic group (SDG), a physician-owned partnership that was historically the basic unit of medical practice. It has recently been replaced en masse with corporate groups whose size and scale are changing the face of medicine, and whose physician employees no longer own their business.
This is not a lament for lost ages, but a recognition that every job is a marriage of sorts. Did the old model encourage employment fidelity while the new one leads to employment polyamory?
Is job turnover less due to the structure of medical practice than a function of the clarity of vision that kids these days have about work-life balance, and what they are or are not willing to accept in trade-offs? Take it away Vagabond...
At the wedding of a radiologist friend in the late-90's, a New York City medical school classmate of the groom and best man at the ceremony stood up to make a toast. It closed with, "My partner for life, George, and I wish you the best...".
My close friend, also a radiologist, elbowed me and said that he wished he were in a medical practice where all the docs had a lifetime commitment, how great that would be. It was before some of us Midwesterners had heard the term "life partner" in the context of a committed homosexual relationship, and when my friend learned of his gaffe, we all had a good laugh over it.
But maybe he was onto something. Any democratic medical group, especially in the era of doctor shortages, exploding demands for service, and a revolving door of both personnel and stakeholders experiences its ups and downs.
Our own radiology SDG has had an insane amount of turnover in the last 12-18 months, including the departure of the last four people we hired, with employment tenures ranging from 10 months to 23 months, none of the four making it to the two year mark. This has created staffing shortages that have hit us hard for the summer months.
As a result, the group's sole part-time partner (yours truly) has had to log a full-time plus schedule. This crescendoed late last month (June) when I had a stretch working twelve consecutive days, including two 11 hour shifts, one 14 hour shift, and two nights until 11 PM. I also have been forced to give up two weeks of summer vacation, like the other partners.
While I was appropriately compensated for the extra work, the money is earned at the highest marginal rates and serves to pad a nest egg that is already deemed to be adequate. Time has become the more the valuable commodity, not additional income. And, needless to say, the burnout factor units are piling up.
So if not for money, why do the extra work? It comes down to the "life partner" mindset. The core of our practice has been together for 10 or more years. (I myself have been with the group 23 years, and the longest tenured over 30 years.) We have struggled through tough times and celebrated good times, both within the context of our professional careers and in our personal lives.
A family-like bond develops, and while there are times that you may be very frustrated or annoyed with one of your partners, if someone from the outside attacks him, you would defend him like he is your little brother.
Despite occasional and sometimes enduring internal conflicts, you just do not let your family down. (My wife might argue that it is more akin to a Stockholm Syndrome, but that's just another perspective.)
In the end, it looks like I am entrenched in one of those "life partnerships." I do have great affection for most of my longtime colleagues and would make personal sacrifices to keep the practice afloat and see them continue to prosper.
I am not sure if I would feel the same working for a corporate practice or as a hospital employee, and I doubt that I will ever know first hand. I also wonder if this is a generational mindset that will not survive much longer, as younger physicians seem to have an arguably healthier more transient and transactional worldview.
Comments 7
My group was like Vagabond’s. It was a band of the hand, all for one and one for all. The group was 5 going to 6 going to 7 as the years went on and we strove to make tings equal up to the 90% level. To work for me you came in understanding you needed to be satisfied with 90%. It’s the kingdom builders and tycoons who try to screw you out of that extra 3% that causes groups to blow up and a small group doesn’t have the slop in it’s social structure to take up the slack. We did cover for each other but if it was a constant bone of contention, bye bye. The loyalty this engendered was amazing. People were dug in, planted roots and raised families. We lost a few to greener pastures and a few who’s skillset didn’t match our needs, but over all we lumbered forward as the band of the hand and slew the MBA’s. Our group had great relationships with the surgeons as well.
In my later years we staffed a SDSC with 2 of us, me and my partner of 25 years. When it came to think about succession planning we sold out to a national company and became employed. It was a different life. A paycheck, corporate mickey mouse to satisfy, good benefits to keep you on board. The national company sold us out to the SDSC goons which was also national level corporation. The Anesthesia corp wanted to prove it’s metal to the Surgery Center corp and we were the calling card. Yes sir! How High Sir?? At some point medicine gets lost in the weeds and you are no longer wed to loyalty and to the intrepid, but to a paycheck. With no roots, no reason to stay. We move from being Physicians and stake holders, to being Nomads, pilgrims in constant search of a stake. Once a pilgrim, one gig is as good as another and the incentives change. Provider or Blogger? A different question than Physician or blogger.
Hi, Gasem, I hope to never work for a national PE-backed corporate group. In fact, I can virtually assure you that I will not, unless I am working for myself, as it appears that you are or were.
When I started practice, I viewed my group practice as a military unit, multiple tasks to accomplish with common goals. Now I’m inclined to agree with Mrs. Vagabond, Esq, the relationship is more Stockholm Syndrome rather than a partnership. While I appreciate my 22 years in two different SDG, after all that is how I reached FI, the hospitals now treat you as a professional only as long as you stay between the lines. Stray outside and they act as if you’re a child throwing a tantrum. IMO the group members are simply fellow prisoners who answer to the same warden. The main difference now with hospital or private equity employment is the warden now takes some of your food first. Beware of any hospital administrator who says “fish (doctors) are friends not food.” It’s not true.
Hi, GasFIRE,
The military unit model works pretty well, too. There is a sense that you will make sacrifices for your unit, even if it would nearly kill you, a “Band of Brothers (and Sisters)’, as it were.
I have been currently been in employment with a multispecialty group for 13 years now. It is a little different than if I was in a single specialty group practice. Right now it is just my radiology partner and myself manning the place and I know we would each take on extra work for the other if something arose. But I agree if I felt like I was an employee and not a partner there would only be so much extra I would tolerate.
Hi, Xrayvsn,
“Life partner” sound much better than “life employee.”
Insightful post, Vagabond. It certainly would be interesting if all docs had a lifetime commitment.
My current situation is different from many of my blogging colleagues, but certainly not unique. I’m a partner of a large (yuuuge) physician medical group, but at the same time, in many respects, I am also employed. The retirement and benefits package is great, which is why it is attractive to younger physicians these days who desire professional stability, financial security, and work life balance. Most physicians don’t leave the group voluntarily. Some people may call it “golden handcuffs”, but others may see it differently and call it a life partnership.
So far… I love my colleagues (a huge factor in work fulfillment), the work is divided in more or less an egalitarian fashion, the benefits and time off are relatively great, and I like it. So I’m sticking with this life partnership.
Crispy Doc… as always, I love your vacation photos. This is a beautiful view of La Concha in San Sebastian / Donostia. I believe this is Mount Urgull, amirite? I can see the Hotel Maria Cristina in the distance, a Luxury Collection Hotel (a points hotel of course) that I have enjoyed. Did you enjoy the lovely pintxos?