The Dying Breed
In 2021 my little office was short-staffed. We had 3 1\2 providers (one physician, 2 full time, and one part-time midlevel.) We were pretty desperately short-staffed, to be honest. It was a combination of needing more people and burnout and complacency combined in the staff. All told during 2021 we received 180 resumes. 25 agreed to an interview.
None were hired.
Are we that bad at enticing employees? We never had this problem before the pandemic. A few factors came into play – and the most pressing was unemployment benefits. Those people giving us their resumes were fulfilling the requirement of three job searches and interviews a week. They had no intention of taking a job, none at all. Before becoming judgy, though, I looked long and hard at myself – what would I have done in that situation? In a heartbeat, I realized I would love to stay home and not work if I could still get paid the same or even more. Added to that is the Covid craziness of the reality that at any moment their kids could have been sent home for Zoom classes. Staying at home made more sense then, and it is just now that my staffing issues are easing up – but at greatly exaggerated pay rates as well. Every hire I have made in the last six months has been at least 3-5 dollars an hour more than pre-covid rates.
There is a certain wonderful awe at living and working quite near an Amazon distribution center. I can order something and before I hit “order” it’s here. The center is about 10 miles from where I live and work. That’s the good side. The bad side is that they pay 17-21 dollars an hour and no experience or education beyond high school is needed. I am writing from Texas, where pay rates have not been traditionally near that high. On top of that, they have excellent health benefits. I simply cannot compete with that. I am a solo provider trying to do this on my own while 75% of all MD and DO primary cares are employed by large corporations or hospital systems. My own health insurance benefits stink, my retirement plan is a vague hope of dying quickly from that first heart attack, and vacation time and CME time is something I feel guilty about 5-10 days a year while I still check messages and send prescriptions.
The employer and business owner in me is mad at this hiring difficulty. The father in me is pleased that people are watching and raising their own kids without daycare and after school care. The citizen of earth in me is glad that people are deciding to live with less and focus more on experiences and family rather than the insane driven work ethic we have collectively had as a country.
The realities of these difficulties – the impossibility of hiring, and then then the crazy difficulties of keeping employees, is the number one reason that I am listening to companies that want to buy my practice and join the corporate world of medicine. I won’t have the same autonomy, flexibility, nor the ability to keep my pet snake Edgar in my office. But when a staff member or provider quits, it will be someone else’s job to replace them, not mine. Many of my fellow blog writers are adherents to DPC (direct primary care) as a response to these post covid pressures. I looked into a concierge care model, and I looked into shuttering this place and punching a clock somewhere else. Burnout is nearly complete here – and these issues are common to all docs that own their own practice, but also common to every Taco Bell, accounting firm, school system – it’s everywhere. I truly feel these are the last years for the private doc, we truly are a dying breed, in every sense of that phrase.
This is so sad…However, I understand better the dilemma of the independent or PP doc in your very detailed description. I would just implore you to think again before selling your practice to a conglomerate. As a member of a specialty which was commoditized decades ago, chronic understaffing still occurs. Not because there is no money or applicants, but because it is an employment strategy. To make more money for shareholders, corporate employers in EM intentionally understaff, leaving the employees(physicians/nurses) to suffer and skirt around the shortage while the patients keep coming. Metrics are still kept on every doc so being understaffed is not an excuse to be behind. And we are expected to keep up our PG scores under these ridiculous conditions as well. I’m sure those seeking to buy your practice will court you with the lie, “Let us take care of this for you…”, but once the bottom line is signed, they don’t. So the burnout continues. Only it transforms into moral injury because the threat of being terminated by not keeping up in an impossible situation that is designed to fail hovers over your head. Plenty of EM docs are stuck in their situation because there are not many options for us to practice independently unless we leave EM.
I remember back in the ’80s, there was a period of time in which fast food franchises were in the news because they had begun hiring retirees, older people and people with disabilities. All of these individuals had insurance and other benefits due to their age, being retired, disabled or a vet so it is not what they sought. They just wanted to feel useful. They showed up on time and were efficient. They became preferable employees. Without knowing your exact situation, have you thought about looking for help from organizations representing these demographics? My own sister who is over 70 and on disability worked for an attorney part-time(she has a paralegal degree). Depending on their situation, some may be limited by hours which may affect their income, but they can still work. Also, what about using unmatched med school grads? I know quite a few docs using these grads as MAs/scribes. This allows the unmatched grads to maintain their knowledge until they can re-apply to residency. In about 8 states they have assistant physician(AP) programs-not to be confused with physician assistant- which grant AP licenses for these grads to work under a doc’s supervision, like a 5th year of med school. Most would be happy to be paid at all(I think they should be). The benefit for them is you teaching and enabling them to maintain their knowledge base. I advise the students that I assist to work at least one year with a physician for two reasons. Most have not matched in at least two cycles so the longer they work with one doc the better they can rebuild their knowledge base and for docs seeking help, changing students every other month is a huge inconvenience. Students also get the benefit of you teaching and writing them a LOR. If you would like to talk more about this, please contact me. Don’t give up yet.
When I practiced some of my best employees were older workers, including a rock star office manager who was let go by a big fancy group in the city because she had turned 65. She worked for the practice until she was 80. I never worried about those employees calling in sick. Dead maybe, but not sick.
Come to the ‘dark side’ of rural Emergency Medicine. You pick your days and are paid by the hour. I gave myself a generous raise when I quit my employed FP practice and started EM. Never looked back. The rural areas are happy to get FP docs, and finding a position is easy. One downside is that burnout is very real! I believe it has the highest burnout rate in Medicine. I’ve certainly gotten there.
So True
Me too, Steve, but Ken just can’t be influenced by the siren call of corporate medicine. More to say on this when I get a little time..
You have EXACTLY described the past two plus years of our office.