How did your parents meet? My parents met while taking the same college class, and I met my husband Frank while taking Organic Chemistry. But that was a distant 33 years ago and times have changed. According to Reuters there are about 55 million U.S. singles and 41 million of them have spent around $1.2 billion on online dating. Last year 17% of marriages started with online dating. A good personality, a nice smile, and good looks are important first-date preferences. Online match-making has dramatically changed the way people meet and marry.
When you were growing up was your family doctor in solo or small group practice in your hometown? Much like dating and marriage today, physician practices are changing. In 2012 Accenture reported that physicians are leaving private practice for hospital employment, a migration spurred by the rising costs of meeting business and technology needs. In the Accenture survey 53% of physicians specifically noted that EHR requirements were pushing them to affiliate with hospital-based healthcare organizations. 57% of physicians were independent practitioners in 2000 and, according to the survey, only 36% would remain in private practice at the end of 2013.
A growing courtship between hospitals and PCPs
Hospitals are aggressively recruiting physicians to become part of the healthcare team. With a smile and a good personality, PCPs are at the top of the desirable list according the Merritt Hawkins physician recruiting firm. In 2006 22% of Merritt Hawkins recruiting requests were for private practice physician placement. Today only 1% of such searches are for solo practice positions. Hospital employment searches have trended up from 11% in 2006 to 63% in 2012. These salaried hospital positions often feature bonuses tied to quality care metrics. This physician placement data correlates with reports on EHR use. 2013 surveys showed that only 31% of solo practitioners used EHRs for Meaningful Use (MU) while 82% of practices with 10 or more physicians had tackled MU.
We can pine away for the old days of physicians finding each other in local communities, but physician recruitment and employment has benefits:
- Access to HIT on a large, integrated scale
- The opportunity to shuck administrative duties for dedicated patient care
- Better control of working hours; better work-life balance
A good nephrologist will soon be hard to find
Recent blog posts have focused on data and reporting for dialysis patients, but nephrologists and Primary Care Providers (PCPs) provide medical management for a large group of pre-dialysis Chronic Kidney Disease (CKD) patients. The American Kidney Fund reports that 31 million people are estimated to have CKD in the U.S. The majority of CKD patients have other chronic diseases including diabetes, hypertension, and cardiovascular disease. How will we meet the medical person-power to manage this patient population?
“Chronic Kidney Disease and the Aging Population” recently published in Kidney International (KI) highlights the perfect storm that is coming our way.1 Life expectancy is increasing in the U.S. and throughout the developed world. In the U.S. the average life span for men is 76.4 years and for women it is 81.2 years. As older people account for a larger portion of the population, chronic illnesses including CKD, DM, CVD and HTN will be the daily work of health care providers, not good news when geriatric and nephrology fellowships are unfilled and PCPs are the leading desirable physician recruits. Drs. Tonelli and Riella suggest in their KI article that providing good quality of life for the growing population of elderly CKD patients means careful CKD management and preparation for dialysis and renal transplant when appropriate. Such complex CKD management will require good integration of care and maximum use of HIT to provide the best care at the right time.
Healthcare organizations may be a good match for young physicians who embrace HIT, coordinated care, and work-life balance. Like the move to online dating, the move to hospital employment may provide CKD patients and able health care providers with more dates, more relationships, and more marriages — a desperately needed perfect match.
Do you see healthcare organizations recruiting PCPs and nephrologists in your area? Does healthcare organization employment offer some benefit to nephrologists? Post a comment with your observations and thoughts.
Reference
1. Kidney International 85, 2014; 487-491.
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