Even so, Chipman had plenty of doubts before signing the deal. “The decision was incredibly hard for me personally,” she said. “I came from the culture of having your own practice and your independence.”
Not so for Dr. Nicole Lee. The first-year fellow in maternal and fetal health at the University of Mississippi will enter the workforce in two years. She expects to go directly into hospital employment. That's because working for a large health system likely will mean less on-call duty, allowing her to balance work and personal life. “If I have a family, they will definitely be my priority,” Lee said. “Being on call every other week is not feasible to me.”
Physician recruiters increasingly face this gap in physicians' professional outlook as health systems continue their doctor hiring binge. But the chasm in experience and expectations also brings a potential source of workplace tension, as doctors accustomed to managing their own business and putting in very long hours work side-by-side with doctors who want to work eight- to 10-hour days and have time for family, friends and other pursuits.
Doctors moving from independent practice to employment may be more autonomous, business-savvy and likely to prioritize work over other obligations. But they also may chafe under bosses and rules. “They're used to setting the rules,” said Dr. T. Clifford Deveny, Catholic Health Initiatives' senior vice president for physician services and clinical integration. “One of the things you give up is that complete independence.”
Younger doctors may have no experience with or desire to take on demanding call schedules or leadership roles. “They're looking for lifestyle,” said Danise Cooper, manager of physician recruiting specialists for Cejka Search and one of the recruiting agency's senior search consultants. “Lifestyle means less call.”
Thrown together, once-independent physicians and younger doctors may clash over how to share the workload and rotation duties. In addition, physicians may differ in how they respond to their employer's invitation to participate in quality improvement or strategic efforts. And since physicians may treat one another's patients, some doctors may worry about how their colleagues' work ethic and attitudes and accessibility to patients may reflect on them and influence their patients' satisfaction.
Cultural discord among doctors can lead to costly turnover. Culture conflict ranked in the top five reasons for turnover among doctors in the most recent retention survey by the American Medical Group Association and Cejka Search. Hospitals lose revenue when doctors depart and incur the cost of recruiting replacements. In 2012, physician turnover edged upward to 6.8% from 6.5% the prior year and 6.1% in 2010, the survey found.
“Turnover is terrible for everybody,” said Dr. Les Mathers, senior vice president for physician recruitment at Peoria, Ill.-based OSF HealthCare. The system operates eight hospitals across its home state and one in Michigan. Between September 2011 and the end of last year, the hospital hired 89 doctors to bring its total of employed physicians to 505.
Twenty percent of U.S. doctors worked for a hospital in 2012, according to the American Medical Association. That figure rises to 26% if you include doctors in a medical practice partly owned by a hospital. Six years earlier, 16% of doctors were hospital employees.