In the animal kingdom migration is natural and instinctual, a relatively long-distance movement of individuals as a group, as defined in the dictionary. It is found in all major animal species. The trigger for the migration may be climate, availability of food, the season of the year, or a major habitat change or disruption. Whatever it is, migration means survival!
So if birds, fish, butterflies, and elk do it, just to name a few, why are physicians doing it? The answer is adaptation for survival due to environmental shifts.
There are approximately 100,000 (or 1/3) fewer doctors in an ownership private practice setting today than in 2000.
Accenture researchers analyzed data from the American Medical Association and MGMA-ACMPE to determine trends in physician independence and practice ownership. Physicians were defined as independent if they owned at least part of a practice.
Source: “Clinical Transformation: New Business Models for a New Era in Healthcare,” Accenture accessed 11/25/2013.
Top concerns prompting physicians to consider employment
Several issues are persuading doctors to think seriously about leaving independent practice. Accenture researchers surveyed 204 specialty and primary care physicians in May to identify the most pressing concerns.
87% cited business expenses.
61% named the prevalence of managed care.
53% were concerned about EHR requirements.
53% mentioned maintaining and managing staff.
39% cited the number of patients required to break even.
Source: “Clinical Transformation: New Business Models for a New Era in Healthcare,” Accenture, accessed 11/25/2013.
More and more physicians are facing excessive business costs as employers in private practice and decide the price of autonomy just isn’t worth it anymore.
The type of practice setting doctors choose is a decision affecting everything from their salary, practice relationships, and the hours they work. What’s more, given the changes taking place in the healthcare arena, selecting a practice model is no longer a simple decision made in one’s final year of residency. Managed care reimbursement for services and formulary protocols and practices restrictions have increasingly changed the healthcare delivery landscape, financial pressures, government regulation, and technological as well as administrative demands from payers— i.e., commercial health plans, GPOs, hospitals, Medicare, and Medicaid are influencing physicians of all ages and stages in their careers to reevaluate their practice decisions just to make a living. “Where is the doctor-patient relationship in all this?” many doctors have asked me over the past few years.
Many physicians after paying all their monthly expenses and staff salaries have little or nothing to pay themselves and turn to market research and advisory opportunities to supplement their income. Many physicians find this increasingly frustrating and start looking for other options like migration.
Migration takes many forms: just walking away and becoming a chief, retiring, teaching/academia, and physician concierge. One doctor I know walked away and just opened a bar. The answer for many physicians is migration to more of an employee type setting.
Let’s just focus on institutional practice and what that means to manufactures and marketers. The physician has moved from employer to employee—a big communications game changer.
Being part of a hospital or institutional setting relieves physicians of many of the financial and administrative burdens of owning/running a practice. It gives them retirement plans and also support services they may not have had before, and enables them to offer their staff better benefits. Doctors I have interviewed have followed colleagues in this migration of selling their practices, and liked the results.
Autonomy is compromised in the new payer-centric environment for survival, and the opportunity for manufactures to have the traditional access to communicate, educate and cultivate relationships is now forever changed.
The implications are profound and we need to adapt traditional forms of communications, and find new and meaningful ways to communicate. We need to take a more critical view of some of the more recent options we tend to look toward, like websites. “No, not another website! We are already pulling down ones that are doing nothing for us!” many manufacturers say. I have heard that more times over the past few years than I can count. Today, a new website or iPad detail aid will not do it. We need to fully understand how physicians today want and need to be communicated to in their new environment; it is not one size fits all anymore. We need to look at institutional barriers to access and develop business-to-business value propositions to gain access. And it doesn’t stop there. We need to look at multiple or customized value propositions by HCP specialties, gender, age, cultural diversity, as well as regional differences to optimize brand opportunities for growth in the brief moments in time we have to communicate. Think of it this way: a 29-year-old female internist in Texas most likely looks through a different lens for communications, information, and decision-making than a 62-year-old male internist in Vermont. What do they have in common? Most likely today they are in an institutional setting, they want to help keep or get their patients well, and they have no time to talk to you in their growing payer-centric institutional environment.
The Way to Adapt
The answer for manufacturers and marketers is that we need to change. Look to nature and migrate how we think and constantly adapt what we do to survive.
The question is, how are you going to activate your migration?
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