Durkin said contractors can hire and fire doctors at will, especially in large metropolitan markets where one contractor is dominant. “I was working for a single-contract dictator,” said Durkin, who is now a self-employed clinician and consultant. “Then I thought, why should I forfeit 20% to 25% of the money I'm bringing in to someone who is doing little more than drawing up a schedule?”
While acknowledging that “there are some well-run groups,” Durkin characterizes many contractors that hire physicians as “hired guns” with little connection to the communities where their doctors work. “We ought to not have fear for our jobs when we advocate on behalf of our patients and do what's right for them,” he said.
The tensions between physicians and outside staffing firms also are being felt by hospitals that increasingly are acquiring practices and hiring physicians. Surveys and anecdotal evidence from physician recruitment firms confirm the existence of widespread tension.
Peter Cebulka III, director of recruiting development and training for Merritt Hawkins, a Dallas-based physician search firm, said certain specialists, even those in high demand, fear being labeled as troublemakers and thus keep their opinions to themselves. “We do come across it quite a bit, and it's one reason why physicians are looking to relocate,” Cebulka said. Doctors want to fix problems, but they are also concerned that being outspoken “may reflect poorly on them down the line.”
The results of a survey released last week by Physicians Wellness Services, a behavioral health company, and St. Louis-based physician recruiter Cejka Search highlight the disconnect between physicians and the administrators for whom they work. One of the 1,666 physicians participating in the survey wrote: “Many hospital administrators seem to think they can demand engagement.”
Physicians were asked what elements of engagement were important to them and to what degree those elements exist at the facilities where they worked. The biggest gaps were found in the statements like “feeling that my opinions and ideas are valued” and having “a voice in clinical operations and processes.”
The recruiters suggest that if physicians encounter problems after speaking out, it often arises from the less than ideal way they do it. They counsel physicians to hone their diplomacy skills and work through established staff processes to address ethical or quality concerns.