The workforce trends scaring physicians 

From consolidation to noncompetes, six physician leaders recently joined Becker's to discuss the workforce trends that are concerning them. 

Editor's note: These responses were edited lightly for clarity and length. 

Clarissa Arthur, MD. Family Medicine Physician in Nashville, Tenn.: The workforce trend for physicians and providers that is most concerning is that of seeing providers as instruments of income production only, rather than as a part of the team. This cultural perspective will cause the decline of work relationships and, ultimately, patients' quality of care.

Marsha Haley, MD. Clinical Assistant Professor of Radiation Oncology at the University of Pittsburgh: Most physicians are employed, yet from a corporate standpoint, they are still treated as independent practitioners. For example, most physicians do not have collective bargaining agreements/union representation, which places them at a disadvantage when negotiating with large health systems. Noncompetes severely limit where and when physicians can practice. The corporate takeover of medicine by private equity can leave physicians at risk of malpractice due to understaffing and high patient ratios. Essentially, the employed physician has little control over his or her working conditions, and employed physicians need better representation.

Loay Kabbani, MD. Vascular Surgery Specialist at Henry Ford Health (Detroit): The loss of physician-owned private practice. This one factor makes physicians vulnerable to the whims of large corporations. As physicians become more and more employed, we lose control of our practice and our patient-physician relationships. The new generation is more about timing in and out.

Udaya Bhaskar Padakandla, MD. President of the Texas Society of Anesthesiologists: The trend that currently concerns me most is the vertical integration sweeping the healthcare industry. Physician practices are being bought out or acquired in a trend that is sweeping across this nation (now 90,000 strong) with Optum. Two things about it bothers me more than any other: This increasingly leads to loss of independence in the decision-making ability of physicians in patients' best interest, and second, government watchdogs (like the FTC) are passive onlookers to this dominance of the physician workforce by a monopolizing entity. But at the same time, much smaller physician groups (with 3,000 to 5,000 physicians) get sued by the same entity for "monopolizing" the marketplace.

Joan Richardson, MD. Professor and Chair of the Department of Pediatrics at University of Texas Medical Branch (Galveston): I am most concerned about decreasing numbers of the pediatric subspecialty workforce due to fewer graduates pursuing training in pediatrics and even fewer choosing to pursue subspecialty training in pediatrics.

Christopher Walker, MD. Physician-in-Chief of Kaiser Permanente Napa-Solano (Vacaville, Calif.): I'm seeing a continued move away from evenings and weekends, especially in 24-hour specialties. I'm also seeing the continued burden of the patient portal where message volumes continue to increase in number and complexity. In states like California where I live, primary care physicians (especially pediatricians) are now having a difficult time finding affordable housing, especially in urban areas. All of these factors have created a milieu where medicine seems more like a consumer-based service and less like a mission.  

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