More Doctors Seeking Salaries

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The Affordable Care Act (ACA) is shaking up the health industry in more ways than one. Many formerly independent physicians and specialists are rushing for salaried positions at their nearest health network.

doctors are willing to sacrifice some income in exchange for job security in the rapidly evolving world of health care
Some doctors are willing to sacrifice some income in exchange for job security in the rapidly evolving world of health care.

For many previously fee-for-service independents, this will naturally result in a pay cut. But doctors are willing to sacrifice some income in exchange for job security in the rapidly evolving world of health care. In fact, in the interim, some hospitals are offering doctors more than what they previously made in order to get them on their team, since hospitals must form networks in order to benefit from some of the incentives in the ACA.

Effects of this new regime change are on both ends of the spectrum. Facilities such as the Intermountain Healthcare (Utah) and the Kaiser System (California) are considered shining examples of how networks can be cost-effective to both patients and shareholders, by focusing on quality of care and not quantity of procedures. Sadly, this is not always the case.

Some hospital see the rush to network as an opportunity to increase costs, whether by adding “facility fees” to procedures or requiring their doctors to only direct their patients to in-house labs and services, a further reduction to doctors’ autonomy in the ACA transitional period.

But economic concerns can easily trump issues of independence, and the pay cuts are somewhat mitigated by other business concerns. For instance, private doctors and private clinics who sell their practices to hospital networks no longer have to pay their own malpractice premiums or find health insurance for their employees.

In the shuffle caused by the ACA, more hospitals are opening urgent care facilities, as opposed to corporate- or physician-owned facilities, in an effort to not only alleviate emergency room crowding but to streamline the referral process. If a patient needs more specialized follow-up care, a hospital-owned urgent care facility will likely refer the patient to a specialist within the hospital network.

Currently, 65% of urgent care facilities can boast at least one on-site physician at all times, but when the dust settles from the scramble for secure, salaried positions, this number could easily go up or down: up, if doctors are looking for stable positions, and down if the higher-paying hospital bids lure them away in the short term. Only time will tell.

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