Op-Med is a collection of original articles contributed by Doximity members.
Doximity’s 2018 US Physician Employment Report suggests that the pressure created by a mismatch of physician supply and demand will increase physician compensation.
This current mismatch of supply and demand is consistent with the Association of American Medical Colleges recent report The Complexities of Physician Supply and Demand Projections from 2016 to 2030, which predicts a total U.S. physician shortfall between a range of 42,600 and 121,300 by the year 2030.
Broadly speaking, the demographics of our aging population is unstoppable, and the future physician supply-demand mismatch is real.
But is this future disparity between physician supply and demand - which this Doximity report theorizes may already be resulting in increased compensation for physicians - really a good thing?
Well, in commodity markets - such oil, gold, or soybeans - a report like this would be fabulous news! What could possibly be better than holding an asset that is in ever-increasing demand?
Unfortunately, despite large healthcare organizations desire to see physicians as commodities (as exemplified by their not-so-subtle desire to label “physician” as "providers“ whenever possible), we are not commodities, so I would temporize any excitement about being in high demand with a grain of salt.
Simply put, unlike oil, gold, and soybeans, physicians aren’t just an unchanging economic asset. We are people - people whose job it is to provide complex services to a wide range of patients at a high standard despite our own specific circumstances, including such quality of life factors as fatigue, family issues, or stress level.
Put another way, from an economic point of view, it’s good to be a physician when there is a “low supply of physicians.”
However, from a clinical and human point of view, it's not so desirable to be a physician during a “physician shortage.”
Now, it’s likely every physician reading this understands what it means to be short one or two doctors in their practice for a short period of time, say a few days.
But working as a physician in any specialty when you have a long-term shortage is another thing entirely because the volume of patients doesn't magically disappear to accommodate you.
Instead, the backup of patients will put you under more pressure - both internally, from a desire to help patients, and externally - from your administrators - to work harder to maintain revenue.
Certainly most physicians I have worked with can accommodate a short period of time of a physician shortage (that is, low supply), but when this extends into months or years, working consistently behind the physician staffing curve will result in low-grade, chronic stress - a suffering in silence - which will not be easily compensated for by a three percent, five percent, or 10 percent increase in salary.
Bottom line: A long-term disparity between supply and demand in healthcare delivery, the most human of services, is bad for everybody; physicians, employers, and patients.
So what's the supply side (physicians) and the demand side (healthcare organizations) to do, knowing this mismatch is going to be inevitably widening over the next decade?
Well, for physicians I suggest this:
When selecting a position (or maintaining your current one), do not become too enamored of the current and future financial compensation.
Take a critical look at the local environment you're working in, with particular attention to whether or not your organization already has a shortage of physicians. If it does, there will be significant pressure for them to maximize their ‘bang for the buck”.
Look carefully at the macro environment, particularly, the state in which you will be working. Consider secondary stressors, such as the State Medical Board punitive culture and the state’s typical malpractice risk. (Take a look at Wallet Hub’s 2018's Best and Worst States for Doctors. Spoiler Alert! South Dakota has the best medical environment rank, whereas New Jersey has the worst.)
And what should large healthcare organizations do about this future physician shortage?
Stop looking at physicians as commodities. (And I'll reiterate this again - if you are calling physicians “providers” you are treating them as commodities!)
Start to understand and study why more physicians are choosing to retire early.
Self-reflect on the known difficult challenges for physicians, such as their frustration with EHRs, the psychological and emotional damage of malpractice, the high rate of physician burnout, and the absolute tragedy of physician suicides.
So, to summarize, the Doximity Report, although encouraging from a short-term financial perspective, is actually somewhat worrisome because to me it indicates difficult times ahead for both physicians and their employers - times which will not be made easier by simply increasing physician compensation by a few percentage points.
Dr. Matthew Rehrl is a physician who has served in a C-Suite advisory role on social media within healthcare for over a decade. His current focus is the ethics of AI in healthcare. He reports no conflict of interest.