By Dr. Jim Dahle, WCI Founder
I attend the Scientific Assembly of the American College of Emergency Physicians most years. This last year, I spoke three times at the event. In between my own talks, I try to cram in as much CME, learning, and networking as possible. I watched some residents and young faculty presenting their research at one point, and I was fascinated to see a short presentation that included the slide below.
The data applies only to emergency physicians, but I thought it was very interesting. For a long time, I’ve been telling people that only 8% of emergency docs actually own their jobs. That’s not entirely true. That’s just the people in democratic groups so small that they only cover a single site. It turned out that my own job, which I very much consider a small and democratic group, now falls into the “regional partnership” category. Apparently, more emergency doctors than I thought are self-employed.
Still, the other statistics are pretty daunting.
How Many Emergency Docs Are Employed by Hospitals or PE?
One-third of emergency doctors are basically just hospital employees, and 25% of them are employed by an entity that is, in the end, owned by private equity. I won’t name names, but those of us in the field know who I’m talking about. You can count them all on one hand. I’m not sure what to do with the “national partnerships” or even the “regional partnerships,” though. The bigger the partnership, the more the job is like working for a Contract Management Group (CMG), which extracts something more like 1/3 of what the docs produce rather than a single-digit percentage for overhead like my partnership does. Even at my job, where the partnership is composed of multiple divisions of 10-20 docs controlling the most important aspects of their jobs, there is increasing pressure every year to standardize everything and run the partnership like a big CMG.
After the presentation, I was interested in learning where all this data came from, so I cornered the presenter and learned about Ivy Clinicians, a startup co-founded by emergency physician Leon Adelman. I then hunted down Leon at the conference and learned all about his career path. His path has been very different from mine with regard to ownership of his job. While I have essentially been in a small democratic group ever since leaving the military, it seems like he has encountered just about every terrible job situation possible due to docs not owning their job. Ivy Clinicians is his attempt to do something about it for him, every other emergency doc, and (hopefully) eventually many other specialties. He aimed to replace the “job boards” out there with a more comprehensive solution.
More information here:
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Step 1 for Leon was to figure out who owned all of the emergency department jobs in the country. This was a lot harder than it might sound. But eventually the task was completed, and that’s where the data on the slide above comes from. I was actually a little skeptical of the quality of the data, so I tried to get some information about my own job. Since I’m on the hiring committee for my division, I figured I’d know the contact person for my group. I didn’t, which increased my skepticism. So, I shot off an email, and a couple of days later, I got an email back from someone at the central office in Denver for my now regional partnership who didn’t know me from Adam.
OK, maybe the database isn’t perfect for a very unique group like mine, but that contact would have gotten me in the right place eventually, I suppose. Although if I were a random emergency doc looking for my job, the contact probably would have at least tried to get me to consider some other places in the partnership that are harder to staff than my division.
Still, I think there is great value being created here. My approach when I went looking for a job upon exiting the military was to call up the EDs in cities with mountains, request the doc on duty, and then ask that doc who did their hiring. I was only interested in small democratic groups (which my group was when I joined) near mountains, so it was a bit of a slow process. Now, young emergency docs can not only shortcut that process, but they can pretty quickly figure out who owns what jobs and, if desired, completely avoid those owned by the hospitals, private equity, and even large partnerships.
Ownership matters. I like owning profitable companies, both my own and others via stock index funds. I like owning my own home and real estate investments. I like owning my job. I think medicine is better—for the docs and for the patients—when docs own their jobs. I recognize not every doc wants ownership, but I still think it should be the standard. Tools like Ivy Clinicians are making that a little bit easier these days.
Most of us complain about the effects of private equity on our workplaces and patient care. Let’s start doing something about it. When it becomes harder for PE-associated employers to hire docs, there will be a lot less PE in medical care.
What do you think? Who owns your job? How does that affect your work? Would you like to change it?
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