How new doctors will kill private practice

What are new medical graduates looking for in their first job?

According to American Medical News, they’re looking for jobs with the following criteria: “The most important items would be the ability to show a stable, growing practice and quality of life … The stability would come from a practice that generates most of their collections from commercial insurance, as Medicare cuts are looming. The ideal quality of life would be a four-day workweek with little to no call. Financially, they would need to offer employment plus production bonus and would need to be above the 50th percentile for their specialty.”

Good gig if you can get it.

Private practice is unlikely to meet those specific demands, which is one reason why the days of the independent physician are numbered.

The answer? Hospital-based practice, or practices that are part of larger, integrated health systems:

More physicians also want or need flexible work arrangements such as part-time hours. This is more possible in an employment arrangement with a hospital or large practice.

“The generational differences, along with reform, and the extreme shortage of doctors have all literally combined and formed the perfect storm.”

Today’s graduates want the financial stability of a salary to pay off rising medical school debt. Those who graduate with over $200,000 in debt range between 20 and 30%, depending on the source.

Furthermore, health reform is going to further pressure physician salaries by cutting Medicare payments. That’s going to make it difficult to thrive in private practice.

The combination of a deteriorating fiscal environment and the desire for a better lifestyle is going to have repercussions in two areas: rural medicine and private practice doctors nearing retirement. According to the article, “Small practices in rural areas will find it even tougher to recruit … Only 6% [of graduating residents] wanted to work in communities smaller than 50,000.”

These factors are leading doctors to seek employment at larger organizations which may be the “perfect storm” that health reformers are hoping for to tilt the country’s doctors away from small, fragmented practices.

New physicians who increasingly value lifestyle and work-life balance will only accelerate this seismic shift.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of, also on FacebookTwitterGoogle+, and LinkedIn.

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