Primary Care’s Preferred Practice Setting
The ongoing shortage of primary care physicians, its effect on hospital administrators, and their respective communities has been well documented in recent years. Healthcare facilities wishing to attract new primary care providers to their facilities are experiencing an increasingly competitive landscape as the gap between supply and demand continues to widen with no end in sight.
There are a number of factors that can dictate why a primary care physician chooses to practice at a particular healthcare facility. It can be argued that the most important factor is their practice setting.
So are healthcare administrators tailoring their practice settings to what’s valued most by primary care doctors? In the fourth quarter of 2009, The Delta Companies set out to answer this question by asking primary care physicians to complete a short survey on their current and preferred practice settings. The following is a summary of the results from those respondents who completed the survey.
Compensation
Survey takers were first asked about their current compensation structure versus their preferred compensation structure. Physicians identified whether they currently had a salary, salary plus production, or income guarantee compensation structure. Almost half of the physicians who responded currently have a salaried compensation structure. Over 43% said they have a structure containing both salary plus production, and income guarantee came in a distant third at less than 8%.
Then when asked about their preferred compensation structure, almost 66% of primary care doctors chose salary plus production, a 22.8% variance from those who currently have this type of agreement. The income guarantee structure also received a positive variance, increasing 10% when physicians were asked if this was their preference. However, the largest variance was with a salaried structure, dropping by 32.5% in preference versus those providers who currently practice under this type of compensation agreement. Salary is the least preferred compensation structure, most likely because a simple salary structure has a compensation limit. A salary plus production structure is most desirable to primary care providers because it allows their income to reflect their level of effort and production.
Call Setting
Primary care physicians were then asked to describe their current and preferred call settings. Survey respondents were asked to choose from compensated call, uncompensated call, and no call with a hospitalist program. A majority of respondents are currently uncompensated for call, almost 20% are compensated for their call, and exactly 28% said they have no call duties with a hospitalist program in place.
When asked about their preferred call setting, no call with a hospitalist program and compensated call both experienced increases in preference by 29.3% and 20% respectively. Conversely, uncompensated call dropped in the preference category by over 49% to a dismal 3% of primary care providers. Almost no primary care providers are interested in uncompensated call, while over half currently work in this type of setting.
This data suggests that because the majority of respondents don’t want call, today’s primary care doctors prefer 100% outpatient practices and it stresses the importance of having a hospitalist program. However, if it is necessary for a primary care provider to round on patients, they want the opportunity for additional compensation in return.
Employment Structure
Providers were also asked about their employment structure. Respondents were asked to choose between hospital and group or solo employment structures. Interestingly, it first appeared that there was almost no change when physicians provided their preferred employment structure in comparison to that of their current practice setting.
Does this mean that primary care doctors are satisfied with this status quo? Upon further review, 26% of respondents did change their response and chose the other employment structure when asked for their preference. Therefore, when hiring new primary care providers, hospitals need to have the flexibility to offer both employment structures.
Conclusion
Based on our survey responses, primary care physicians prefer the following practice setting:
• Salary plus production
• No call with a hospitalist program
• Group or solo employment structure
However, if a healthcare administrator cannot offer the “perfect” primary care position, what aspect of the practice setting is most important to physicians when they consider a new job opportunity? This was the final question asked to primary care physicians.
They responded by identifying call as the overall most important factor, with compensation second, and employment setting as least most important when considering a new position. By providing healthcare administrators and facilities with this data, they can compete for these physicians at the highest level and attract the widest possible audience of candidates to their opportunity. In return, primary care providers will understand their strongest negotiable points during the interview process.
About the Authors
Thomas Riddle is a Senior Consultant with Delta Physician Placement and Michelle Longman is a Senior Marketer with Delta Locum Tenens. Both are members of The Delta Companies Thought Leadership Council. The Delta Companies has been a recognized leader in the healthcare staffing industry since 1997 and offer permanent and temporary staffing solutions nationwide for physicians and allied healthcare professionals through four companies: Delta Physician Placement, Delta Healthcare Placement, Delta Locum Tenens and Delta Flex Travelers.