Become a doctor…and then what?

When I was considering entering medical school in the 1990’s, I was focused on the idea that I wanted to be a doctor.  Like many in my position, there was little thought about where I would practice and what that practice would look like.  Most of my experiences with medicine to that point had been through interactions with a small town, private pediatrician.  As a result, that is what I knew of medicine.

Once I entered medical school in 1998, little did I know I was on preprogrammed path seemingly designed to produce more doctors to work in academic medical centers.  We had no training on how to find private practice jobs and a natural progression was to enter an academic medical career.  Fortunately, when I was looking to enter the medical workforce, I stumbled upon essentially the one and only site back then which listed physician jobs, PracticeLink.com.  Today, there are many other options, such as LinkedIn, Indeed, and DocCafe.  New students can now learn about a variety of options and not be drawn into a limited pool of academic jobs.  Now that you know you have many places to look for work, what kind of work environment will you find?

In the 1980’s, 76% of practices were physician-owned.  From 2012 to 2022, the proportion of physicians who worked in practices owned by physicians dropped from 60% to nearly 47%.  Over the 40+ years from the 1980’s until now, a dramatic shift has taken place, where nearly 78% of doctors are now employed by hospitals or other corporate structures.  This shift in organizational structure in medicine has brought with it several problems doctors experience:

• Non-compete clauses – Should a doctor want to leave their employer, they often cannot practice within 20-50 miles for two years.  This restriction prevents doctor flexibility and often traps physicians in jobs due to partner/spouse work arrangements and/or children in school.

• “Golden Handcuffs”

  • Sign-on bonus – Doctors are typically offered a substantial sign-on bonus (e.g., $25,000-50,000+).  For people leaving medical training programs with $200,000-$400,000 medical school debt, the sign-on bonus is welcome extra money.  The problem is should a physician choose to leave with a defined period, such as their first two years, they are responsible for repaying their sign-on bonus.

  • Loan forgiveness – As medical school costs are dramatically rising, employers are using another option to incentivize new doctors to join their system by offering loan forgiveness.  But, much like the sign-on bonus, there is often a requirement to continue to work with the employer for at least two years.

As I mentioned earlier, there are problems many of us have experienced in finding doctors.  There are numerous issues contributing to the supply-demand mismatch of doctors in your local community.  One issue not often referenced regarding the supply of physicians is that doctors have gradually been leaving traditional medicine and entering direct care models known as Direct Primary Care (DPC) and Direct Specialty Care (DSC).  By entering DPC/DSC, physicians can practice personalized care through a direct interaction between the doctor and their patients, without the burdens of large system administrations and having to deal with insurance.  Also, by entering DPC/DSC, the doctors can avoid the “Golden Handcuffs” referenced above.

Are you interested in a primary care pathway, but don’t want to work in a big system burdened by insurance? Consider DPC and investigate the DPC Alliance.  Are you more interested in other specialties besides primary care, then investigate the DSC Alliance for other specialties?  If you want to know what DPC doctors are in your area, look at the DPC Frontier Mapper.  Doctors who want to learn more about DPC/DSC should listen to the excellent podcast by Dr. Concepcion, My DPC Story.