The following post comes courtesy of Vagabond MD, a radiologist who cut back who is a friend and much revered guest-poster on this blog and many others.
In it he addresses the (possibly vanishing) culture of his single-hospital democratic group (SDG), a physician-owned partnership that was historically the basic unit of medical practice. It has recently been replaced en masse with corporate groups whose size and scale are changing the face of medicine, and whose physician employees no longer own their business.
This is not a lament for lost ages, but a recognition that every job is a marriage of sorts. Did the old model encourage employment fidelity while the new one leads to employment polyamory?
Is job turnover less due to the structure of medical practice than a function of the clarity of vision that kids these days have about work-life balance, and what they are or are not willing to accept in trade-offs? Take it away Vagabond...
At the wedding of a radiologist friend in the late-90's, a New York City medical school classmate of the groom and best man at the ceremony stood up to make a toast. It closed with, "My partner for life, George, and I wish you the best...".
My close friend, also a radiologist, elbowed me and said that he wished he were in a medical practice where all the docs had a lifetime commitment, how great that would be. It was before some of us Midwesterners had heard the term "life partner" in the context of a committed homosexual relationship, and when my friend learned of his gaffe, we all had a good laugh over it.
But maybe he was onto something. Any democratic medical group, especially in the era of doctor shortages, exploding demands for service, and a revolving door of both personnel and stakeholders experiences its ups and downs.
Our own radiology SDG has had an insane amount of turnover in the last 12-18 months, including the departure of the last four people we hired, with employment tenures ranging from 10 months to 23 months, none of the four making it to the two year mark. This has created staffing shortages that have hit us hard for the summer months.
As a result, the group's sole part-time partner (yours truly) has had to log a full-time plus schedule. This crescendoed late last month (June) when I had a stretch working twelve consecutive days, including two 11 hour shifts, one 14 hour shift, and two nights until 11 PM. I also have been forced to give up two weeks of summer vacation, like the other partners.
While I was appropriately compensated for the extra work, the money is earned at the highest marginal rates and serves to pad a nest egg that is already deemed to be adequate. Time has become the more the valuable commodity, not additional income. And, needless to say, the burnout factor units are piling up.
So if not for money, why do the extra work? It comes down to the "life partner" mindset. The core of our practice has been together for 10 or more years. (I myself have been with the group 23 years, and the longest tenured over 30 years.) We have struggled through tough times and celebrated good times, both within the context of our professional careers and in our personal lives.
A family-like bond develops, and while there are times that you may be very frustrated or annoyed with one of your partners, if someone from the outside attacks him, you would defend him like he is your little brother.
Despite occasional and sometimes enduring internal conflicts, you just do not let your family down. (My wife might argue that it is more akin to a Stockholm Syndrome, but that's just another perspective.)
In the end, it looks like I am entrenched in one of those "life partnerships." I do have great affection for most of my longtime colleagues and would make personal sacrifices to keep the practice afloat and see them continue to prosper.
I am not sure if I would feel the same working for a corporate practice or as a hospital employee, and I doubt that I will ever know first hand. I also wonder if this is a generational mindset that will not survive much longer, as younger physicians seem to have an arguably healthier more transient and transactional worldview.