If you’re a physician in private practice, there may be very few doctors following in your footsteps, according to results from athenahealth’s 9th annual Epocrates Future Physicians of America Survey.
Among medical students who responded to the survey, 73% said they plan to seek employment through a hospital or large group practice; a mere 10% said they hope to join a private practice, down from 17% the previous year. One reason for the employed practice-setting preference: med students feel their training doesn’t prepare them for the challenges of running a business. Fifty-seven percent expressed dissatisfaction with their education in practice management, and 65% reported feeling unprepared for the exigencies of billing and coding.
When asked about their “top concerns,” 60% of respondents cited a desire for work-life balance as number one. That, along with an apparent aversion to the administrative hassles of private practice, helps explain this year’s findings.
However, when OrthoBuzz asked members of the JBJS Resident Advisory Board to comment on these findings, another side of the story emerged. Daniel Hatch, MD, a fifth-year resident at Penn State Hershey Orthopaedics, said, “I am a huge proponent of private-practice medicine and hope to join a private-practice group when I am done with training, but I too feel the pull toward employed positions with guaranteed high salaries for the first few years and large signing bonuses. But I am looking for more autonomy and control in the decision-making related to my practice.”
Orrin Franko, MD, a chief resident at UC San Diego, concurred: “Personally, I desire the independence of private practice and do not fear the inevitable challenges I will face by running a business—but I am in the small minority,” he said. “I have seen first-hand the personal satisfaction, financial success, and independence of private-practice surgeons, and I desire that for myself. I hope that more of my colleagues feel the same way. Otherwise, I feel we are at risk of losing control over our specialty to large hospital systems and payors.”
For Benjamin Service, MD, a resident at Orlando Health, the choice is “not simply academic versus private practice versus hospital employed…due to the variation in orthopedic practices.” Dr. Service agrees with the survey’s findings about subpar private-practice preparedness. “US medical schools are severely lacking in educating their students on debt management, finance, asset protection, and practice management,” he said. “It is obvious that many students would not initially consider private practice due to this gap in our education.”
What do you think? Please let us know by clicking the “Leave a comment” button.
Orrin Franko, MD is a fifth-year orthopaedic surgery resident at University of California, San Diego. He has an interest in researching and promoting the orthopaedic uses of social media and mobile apps. In addition to multiple publications on these subjects, Dr. Franko is the founder and creator of TopOrthoApps.com, a website that reviews mobile apps for orthopaedic surgeons. We appreciate his willingness to answer a few questions for OrthoBuzz.
JBJS: Looking back on this year’s AAOS Annual Meeting in New Orleans, what were some of the highlights for you?
Dr. Franko: I was impressed by the combination of traditional posters, digital videos, and presentations. With regard to mobile technology, I was pleasantly surprised to see such a dramatic increase from just two years ago. This year I saw four posters that developed or validated a smartphone or tablet app for clinical use and patient care, something that I have never seen before. On the exhibit floor, iPads are now a ubiquitous platform for displaying education about products, and many new products integrate wireless capabilities and iPad functionality directly into their use.
JBJS: You presented several times in the Electronic Skills Pavilion at AAOS. Tell us a bit about the sessions and the audience response.
Dr. Franko: The Electronic Skills Pavilion provides a unique presentation opportunity for surgeons to give 45-minute talks on a variety of technology-related topics such as social media, practice websites, search engine optimization, and digital photography and videography. This year, I gave three talks on using mobile apps (iPad and iPhone) for education, patient information, and practice enhancement. The talks were very well attended, which suggests to me that surgeons are eager to learn how to use technology to improve their practice and efficiency.
JBJS: How have you seen the attitudes of orthopaedic surgeons toward mobile technology and apps change over the past 3 years?
Dr. Franko: The past 3 years have shown a clear up-trend in the prevalence and use of apps in hospitals and clinics among both residents and surgeons. This is reflected not only in my personal experience, but also in various studies that have assessed mobile-device usage among all physicians and specifically among orthopaedic surgeons. Using a phone in the hospital is no longer a distraction; it’s a critical educational device.
JBJS: What would you say to orthopaedists who are concerned about HIPAA compliance when using apps?
Dr. Franko: HIPAA will always be a “hot topic” with regard to mobile and wireless devices. This stems from a combination of fear about new technologies that are not well understood, and from the learning curve associated with the introduction of any new technology. First, I would remind everyone that historical medical documentation and care utilized paper charts, standard phone lines, fax machines, and text pagers—none of which are encrypted or HIPAA-compliant. In contrast, mobile devices, text messages, phone calls, and email are much more easily encrypted and protected from data breaches.
Admittedly, these systems are not perfect and never will be. However, if appropriate steps are taken to reduce risks, most hospitals permit the use of all these devices. Generally speaking, surgeons should be aware of patient information that is stored directly on their device versus “in the cloud” (on a remote server at another location). And, if information is stored in the cloud, this should be encrypted at a minimum. I equate the current status of mobile technology for patient care to the off-label use of FDA-approved medical devices: as long as surgeons are aware of how these new technologies work and take measures to protect their patients while working within the restrictions of their hospitals, they should be able to safely implement information technologies that benefit their patients.
JBJS: How do you think JBJS can best address the needs of orthopaedic residents?
Dr. Franko: I think JBJS is taking important steps to address residents’ needs to obtain reliable, peer-reviewed orthopaedic information. As a result of Google, the current generation of residents is accustomed to free, unlimited, and contextually searchable information without delay. This is in stark contrast to searching for archived journal articles on library shelves. By providing fully searchable article titles and full text with the ability to download PDFs for offline viewing, JBJS allows residents to find the information they need when it’s needed. Whether this is provided via a traditional website or via a mobile app is a decision of the journal, but mobile apps have proven to be efficient and reliable tools for journal reading.
(Editor’s note: The recent launch of JBJS Reviews included a free app for use with iOS and Android devices.)
JBJS: What trends in orthopaedics are you most intrigued by?
Dr. Franko: I am most intrigued by the ability to engage patients in the mobile sphere and help them to be participants in their own care. The increase in medical knowledge is true not only for residents and surgeons, but also for patients. Our patients have the ability to learn more about their diseases and potential treatment options than ever before, and they present to our clinics and hospitals with sophisticated questions and expectations about their care. I would like to see technology bridge the gaps between physicians and patients with regard to education and outcomes, while also potentially collecting useful data that can help guide further treatment.
JBJS: Looking ahead to the next 20 years, what three significant advances or changes in orthopaedics do you foresee?
Dr. Franko: While I cannot predict the future, I am hopeful that we will see technology enhance three specific areas of orthopaedic surgery. First, I expect to see drastic changes in resident education that utilize a combination of new technologies to disseminate orthopaedic information. That will include interactive digital journal club discussions, video and web-cast surgical techniques, online board-preparation courses, and curriculum changes that accommodate new work-hour restrictions. Second, I anticipate that medical record digitization will no longer be a burden and will rather demonstrate its potential benefits by improving clinical efficiency, patient safety, and enhancing outcomes research. Third, I am interested in watching the transition to universal healthcare and its impact on healthcare economics and ultimately patient outcomes. This will, in turn, greatly influence practice models and surgeon compensation for my generation of surgeons. That, in turn, will affect the way medical advances are developed and introduced into the field.
JBJS: What is your favorite thing about your profession?
Dr. Franko: The patients. Every day I have the opportunity to help people who are deeply motivated to improve and return to activity, which motivates me to help them in any way possible. My second favorite aspect of my profession is having such diverse and open-minded colleagues who are both exceptional clinicians as well as researchers. As a result, there has been great interest in studying the utility of new technology for the benefit of patient care.