When it comes to hiring a graduating emergency medicine resident, how responsible is the employer to bring the new physician along and establish the foundation of a career? I've been pondering this question for years. With the dramatic increase of emergency physician job opportunities and the intensity of the current market, employers are grabbing graduates with promises of big incomes, partnership deals, sign-on bonuses, and other perks. But how many employers are acting as mentors or offering business and documentation training, assistance with board certification, and a reasonable entry into the incentive income track that reduces potential risk? The answer is not many.
I've been contacted by many 2009 graduates who have found themselves tossed into the deep end of a pool with slippery edges. They are swimming in fee-for-service or straight production-based incentive pools with considerably lower coverage levels than they were told to expect, creating high stress and doubt about their professional abilities. Some were even chief residents accustomed to being the top producer in a high-volume, high-acuity ED. That scenario in residency is different from the one where physicians are expected to move patients at a rate exceeding standards set by both ACEP and AAEM to garner high income for the profit shares.
Case in point: Dr. A takes a job with a democratic, private physician-owned group with promises of fee-for-service riches. He is paid well, and the facilities are top-notch. This pales, though, because of how fast he is expected to push patients through. A few older doctors nearing retirement feel the same way, but they've got to stick it out until they can afford to retire. The workload exists because the so-called democratic group is run by younger doctors accustomed to lower coverage and higher profits. Less than six months into the job, Dr. A decides he wants to move on before he is lured into putting on the golden handcuffs and compromising his principles on patient care. Who's responsible? The doctor certainly should have looked more carefully at coverage when interviewing, but what about the group leaders?
Another case: Dr. B was promised things that still have not occurred in more than a year, including that pay would be incentivized with RVU compensation. After a two-day lecture series and introduction to the hospital, he was seeing patients with no direction or mentorship. Within two months, he started receiving report cards comparing physician efficiency, comparing him with doctors who had been practicing for 20 years. This doctor is holding her own for now, but who is responsible? This employer failed to fulfill promises and provided no leadership.
Brad Courter, MD, the chief operating officer of the Carolina Emergency Medicine Physician Associates (CEMPA) in Greenville, SC, said hiring a new graduate is a two- to three-year investment for the employer. “Employers must increase their responsibility and improve the mentoring of new physicians,” he said. “Assuming clinical competency, employers must take the next step of educating new residents in multiple real-world skills.”
Dr. Courter said larger groups have an advantage because they have similar age and life-phase peers, colleagues, and mentors and a larger administrative support staff. “The happy ED physician who stays and becomes involved for a 25 year-career at his first job is your easiest employee in the long run,” he said.
Gar LaSalle, MD, the chief medical officer for TeamHealth, said the company has a “Beyond the Medicine” program that presents lectures to residencies about the business of emergency medicine. “If we do our job well, we provide the EM practitioner a hassle-free process so that he may practice excellent clinical medicine.”
Mark Harris, MD, TeamHealth's senior vice president of emergency medicine, and his wife Susan developed a concierge service that helps recruits acclimate to their new community and find resources to support a family's needs. TeamHealth has low turnover, largely because of services such as scheduling, credentialing, coding, and billing that it provides.
“Recruitment doesn't end when the physician starts working,” said Chris Michos, MD, the chairman of emergency medicine at Waterbury (CT) Hospital. “It's up to a graduate's first employer to provide orientation in the policies and procedures of the hospital and the department. The best way to accomplish that is pairing a new grad with an experienced mentor physician and for directors to make themselves readily available.”
He added that he evaluates physicians starting at three months, but also asks them how well the group has done helping them adapt to the department. “Orientation and transitioning has to take place on shift in real time, and our docs not only enjoy the mentoring, they find their own work levels improve because of it,” he said.
Physician job-seekers must take some responsibility for the choices they make, but without guidance from most residency programs, they are usually tossed into the deep end to sink or swim alone. Their susceptibility to the lure of big bucks despite potential high risk continues to prevail. If employers took some responsibility for transitioning graduates into new roles and tried to market their positions more accurately, we might see less burnout and fewer graduates leaving their first jobs in two years or less.
Read Ms. Katz's past columns in the EM-News.com archive.