Employed Doctors: Love the Paycheck, Hate the Rules

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Where Employment Falls Short

Not all is rosy for employed doctors. Many feel that they've traded away control over their decisions and influence over their environment, and they're saddled with a flood of new rules to follow. Some typical comments: "The administration functions like the mafia"; "I don't get bossed around, but I do have to kiss butt"; "I can take a vacation without losing pay!"; "No control over the hiring or firing of support staff"; "Zero input into management decisions."

"Lack of autonomy is the biggest complaint we hear," says Tommy Bohannon, Divisional Vice President of Merritt Hawkins, a leading physician search firm headquartered in Irving, Texas. "I suspect that as years go by, we'll see more doctors reporting that they are more satisfied in employed settings because they didn't come in with a preconceived notion that it was going to be a nightmare. I think it's more the perception of loss of autonomy than the actual loss of autonomy. At the end of the day, doctors in private practice work for their payers and have all kinds of rules and restrictions, too."

Cejka suggested why some employed doctors are unhappier with their new situation. Although most probably expected to lose some autonomy and control, the reality is tougher than anticipated. "All humans think that if they move into a large organization, they'll get all the good things and none of the bad things," says Cejka. "Reality is different."

Did Your Work-Life Balance Improve When You Left Private Practice?

Many doctors who became employed breathed a sigh of relief over having more free time. More than half of formerly self-employed respondents (56%) said their work-life balance definitely improved after they changed to employment.

In particular, 33% said the work-life balance became better after becoming employed, and another 23% said it was much better. For about 29% of respondents, the work-life balance remained the same, and for 15% it became worse.

Satisfaction With Autonomy at Work

The phrase "herding cats" is often applied to doctors because doctors are known for having a strong independent streak. How does that fit with having to adapt to an organization with more bosses and more rules?

Less than 50% of employed respondents were satisfied with their degree of autonomy, while about a quarter were neutral, and another quarter were unsatisfied. Rules about how to practice medicine, procedures to follow, and requirements for reporting made many doctors feel a loss of autonomy. While self-employed doctors may sometimes or often have the final word in practice decisions, many employed doctors felt that they did not.


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