Twenty-five years ago when I became an emergency physician, the gossip of the day was about who lost a contract or who “stole” a contract. I was saddened to hear the story of a dedicated colleague who lost his job after years at a hospital when a new contract took over. Today, there is the same gossip, but on a grander scale. With the trend toward hospital mergers, mega-group consolidations, and foundation models (a legal method used by hospitals to employ physicians in states like California that have a ban on the Corporate Practice of Medicine), many might assume that small, independent emergency medicine groups will soon be extinct. But these groups—which benefit both hospitals and patients—survived managed healthcare of the 1990s and will remain past the Affordable Care Act and the resulting consolidation in the healthcare industry.
The benefits of independent emergency medicine groups
Independent emergency medicine groups are surviving despite all the changes in healthcare because they offer lower turnover, experienced staff, and leaner operations than large groups that have administrative overhead. The large groups and hospitals that employ ER physicians may offer big salaries as enticements. However, when these physicians leave due to “sweat shop” conditions where they work long hours, get the least desirable shifts, and have little say about how things are done in the ER, the hospitals and large groups are forced to entice new physicians quickly with even higher salaries. And the vicious and expensive cycle begins again. A hospital would be better off hiring an independent group that provides stability through job satisfaction.
Patients also benefit from independent emergency groups. Greater job satisfaction equates to happier physicians, and happy physicians mean more satisfied patients. With patient satisfaction, a huge goal of hospitals today, hospital administrators should consider the patient satisfaction score of an ER patient treated by a physician who is miserable on the job vs. the score of a patient treated by an emergency medicine physician who is happy to be there.
Independent emergency medicine groups also provide a more diverse set of physicians who can offer a variety of experiences. Hospitals that employ ER physicians and large groups, on the other hand, tend to end up with younger, less experienced physicians (who were enticed by offers of big salaries) or older physicians who soon retire, leaving the large groups and hospitals with a less experienced ER staff.
Why I practice in an independent group
I admit, I joined a large group out of residency and enjoyed some of the benefits such as the QI programs, learning from senior physician leaders, and collaborating with physicians from other hospitals. However, as our group members’ paychecks were shrinking from month to month, we realized things needed to change. We confronted administration and, for the past 10 years, have been running our independent practice, which improved the physician mix and increased physician reimbursement by over 100%. I am glad to be a member of an independent emergency medicine group at Scripps in San Diego, and I encourage medical students, residents, and practicing emergency medicine physicians to consider the independent route.