The number of employed physicians is skyrocketing, and many leaders are concerned about how this workforce evolution will affect care quality.
Quentin Durward, MD, a neurosurgeon at the Center for Neurosciences, Orthopaedics, & Spine in Dakota Dunes, S.D., joined Becker's to discuss why he believes private practice physicians are better incentivized to provide quality care.
Editor's note: This response was edited lightly for clarity and length.
Question: Amid the decline of private practice and the trend toward employed physician models, how is care quality impacted?
Dr. Quentin Durward: I have some personal experience with this because the first three and a half years after my residency, I was an employed neurosurgeon at Dartmouth. I was working in the academic model, which is still employment. One of the problems with an employed model — and I can say firsthand because I've seen it and lived in it — is that there are a number of physicians who are highly motivated people and will work hard no matter what, but there are also a number of physicians who will take advantage of an employed model and try and get by with doing sort of a minimal amount of work to get their paycheck.
And although many employed models try to offer some incentive-based payment, based on how much the production, etc., rarely is it enough to innovate. There are people who work harder. I personally think that physicians who are employed often do not deliver as much time and effort in patient care as those that are in private practice. In private practice, you have to produce in order to cover your overhead, which is becoming exponentially higher and higher these days. You have to work hard if you're going to have enough income to support the lifestyle you want.
Q: Do you think that this will affect patient care in the years to come?
QD: You don't survive in private practice without very, very good patient outcomes. You're dependent on your reputation in the community, and you're dependent on doctors referring to you because they know they can trust you, and they've seen your work in their own patients. It's very different when there's an employment model, whether it's a university-based system, a large group practice or hospital-based system, the system is the one that has the reputation. Physicians can coast in a situation like that. They can basically be much less apparent to the doctors referring to the system, or they are guaranteed referrals by doctors who are employed by the system.
In my opinion, you need to be as nearly on your toes and maintain the very, very best standard you can if you're in a private practice model vs. an employment model, because if you're not good in a private practice model, you sink.