Career Resources articles posted on NEJM CareerCenter are produced by freelance health care writers as an advertising service of the publishing division of the Massachusetts Medical Society and should not be construed as coming from the New England Journal of Medicine, nor do they represent the views of the New England Journal of Medicine or the Massachusetts Medical Society.
By Thomas Crawford, MBA, FACHE, faculty, Department of Urology, College of Medicine, and affiliate faculty, Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, and Samantha Azadian, student, University of Florida
You are a scarce commodity. This simplistic assertion has been captured quantitatively through numerous forecasts that predict a growing chasm between the current quantity of physicians (all specialties) and the growing aggregate demand for health care services. Additionally, it should be noted that this issue compounds as the baby boom demographic continues to age and, subsequently, consumes an unprecedented amount of the health care resources. This assertion is currently manifesting in the primary care and mental health specialties, leading the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) to designate health professional shortage areas (HPSA) and create various federal incentives, such as grants and discounted pharmaceuticals, for practicing within these identified communities. The following data highlights the magnitude of the current dilemma:
As of September 30, 2009, there were
6,204 primary care HPSAs with 65 million people living in them. It would take 16,643 practitioners to meet their need for primary care providers (a population to practitioner ratio of 2,000:1).
3,291 mental health HPSAs with 80 million people living in them. It would take 5,338 practitioners to meet their need for mental health providers (a population to practitioner ratio of 10,000:1)1
The national shortage of physicians that fosters intensive recruitment, growing underserved areas, and federal interventions will deepen over the next 10 to 15 years. Nevertheless, understanding your status as a scarce commodity in constant demand leaves maintaining a work-life balance completely up to you. Based on this premise and before searching for your next position, it is imperative that you and, if applicable, your significant other, create a single ascending list of personal and professional priorities. However, in health care, you cannot have a professional priority that does not affect your personal life and vice versa. For example, call coverage (emergency department and practice) will affect the time you have available for your family, and the local hospital’s medical staff bylaws may determine where you can live and where you send your children to school. Your list will also help you formulate interview questions (think in terms of call coverage requirements, loan forgiveness, sign-on bonus, and geographic restrictions).
This list of priorities will crystallize your search criteria and will help you filter out numerous positions; however, it is always important to realize that if a particular geographic location is your number one priority, you may inadvertently sacrifice a preponderance of your negotiating leverage for that specific location (meaning you assume more risk). For example, if your top priority is to be in a metropolitan area and your next highest priority is to offset your medical school debt through loan forgiveness, you may find yourself in the unenviable position of sacrificing your location and time for income. This is because it is very unlikely that you will receive loan forgiveness in any area dominated by for-profit health systems that are saturated with physicians competing in private practices. This paradigm is referred to as the location reality check. Are you willing to sacrifice your time (and, potentially, your negotiating leverage) for the perfect location? The answer will be captured within your ascending list of priorities.
Nevertheless, much like the income guarantee, thorough business planning is required to ensure that you will be able to generate your desired income while maintaining your quality of life. A number of physicians find themselves trading quality of life for quantity of income in a productivity model. A seasoned member of my medical community underscored this point when I approached him about covering call for me. I told him that I would pay him a significant sum to cover a hole in the schedule during the upcoming weekend. His response was, “I can’t, my son has a baseball game.” Looking at a physician in his mid-60s, this response took me by surprise; nevertheless, I persisted. “Name your price, just promise not to tell your colleagues,” I countered. The physician closed my office door and stated the following, “Let me put it this way, I will be there for my second wife and second set of children… Do you understand what I’m trying to tell you?” This individual had been a pillar of the medical community for decades and I now understood that time was simply more valuable than money. My reply was humble and swift, “Point made and I’m sorry for pushing the issue.”
Remember, recruitment is like being courted and the contract, essentially, is your prenuptial agreement. The time to ensure that your interests are protected is when the relationship is strong, not when it begins to deteriorate. How successful would you be negotiating a prenuptial agreement after you’re married, or worse, in the midst of divorce? Finally, as a scarce commodity I firmly believe that you can negotiate a contract that balances the delicate ecology that exists between professional satisfaction and personal happiness; however, you need to prepare yourself for the discussion and be willing to create clear expectations that protect your most valuable resource — your time.
1 HRSA Shortage Designation: HPSAs, MUAs & MUPs, 2010