Harry Severance, MD, an adjunct assistant professor at Durhan, N.C.-based Duke University School of Medicine, joined Becker's to discuss how physicians increasingly moving to employed models has shifted the workforce to what he calls a "seller's market."
Editor's note: This interview was edited for brevity and clarity.
Dr. Harry Severance: Physicians have been marginalized into "employee status" in our increasingly mega-health system corporate structures. They are found on less than 14 percent of any major hospital/health system top decision-making boards (and it is suspected that the majority of those leaders no longer see patients), and have been removed from any significant major decision-making positions in most hospital systems. There are increasing reports that many mega-corporate hospital system leaders see physicians (and nurses and other healthcare workers) as an oppositional force. They face increasing violence within their workplaces, as well as denigration, overwork, burnout and abuse, in many workplaces, even from their own managers and administrators.
In fact, their only real point of leverage within the system as it currently stands, is that they are a fast-disappearing commodity: Over 50 percent of currently practicing physicians are over 50 years old or older, [according to the American Association of Medical Colleges]. A shortfall of 54,000 to 139,000 physicians is estimated by 2033. There are currently inadequate numbers of residency training programs in the U.S. — far less than the total number of medical students who graduate from U.S. medical schools each year. Though physician-managed hospitals have been shown to avoid most of the major calamities currently facing the majority of healthcare systems, very few currently exist, and most have been legislated away by regulations and laws limiting or preventing such physician-run organizations — concerned over unfair competition and kickbacks.
Some argue that such a shortfall gives those remaining in clinical practice the advantage of a seller's market. A seller's market might encourage competitive healthcare systems to want to detoxify their healthcare workplaces as an enticement to better attract increasingly scarce physicians and other healthcare workers.
That's not the same thing as physicians themselves utilizing their "seller" status!
Physicians, as a group, have always been like herding cats and have, for decades, failed to achieve any unanimity and broad-ranging organizational strength that can counter healthcare corporate entities. They not only have difficulties with unified postures within their own physician groups, but they also generally fail to consistently partner with other healthcare workplace players to present a unified front to management on issues surrounding the healthcare workplace!
Hence, one reason for the rise of healthcare unionization, including physicians unions — thus providing an organizational structure specifically designed to confront abusive managements and leaderships and force them to the "bargaining table" — the specter of collective bargaining! However, not all physicians are permitted by federal and state laws to join unions. Also, unionized physician conditions can give corporate and government entities even more impetus to attempt to replace physicians.