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.”
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According to the JBJS 2014 Readership Study, residents are frequent users of mobile medical apps, with 76% saying they have a medical app on their smartphone. Over the next 2 years, residents anticipate that their app usage will become an even greater part of their daily use. According to the study, just over half of residents, 52%, say they expect to rely heavily on mobile apps for obtaining clinical orthopaedic information. Residents place mobile apps 4th out of 8 sources in future reliance, with online journals in first place. Orthopaedic surgeons, on the other hand, rate mobile apps lower in future importance, with roughly a third, 36%, saying they’ll rely on mobile apps the most. For surgeons, online and print journals are at the top of the list.
Despite an average resident salary of $55,330 a year and over a third (36%) claiming they owe more than $200K in loans when they finish residency, 83% of residents polled by Medscape said they are still looking forward to practicing as a physician. Medscape’s recent survey, Residents Salary & Debt Report 2014, polled 1,200 residents across 25 specialties and revealed that orthopaedic residents make an average annual salary of $57,000. The highest average resident salaries of $65,000 are in critical care, and the lowest ($52,000) are in family medicine.
Despite low salaries, heavy debt load, and long work hours (66% of Year 1 residents spend 60+ hours a week at work), roughly half (48%) of male residents and 60% of female residents said they are compensated fairly.
Gender influences salaries in resident programs, but the male/female differential is only 4%, much lower than the 24% difference by gender among non-resident physicians. Geography also makes a difference in resident pay. Residents in the Northwest receive the highest salary (an average of $71K) followed by those in the Northeast, with an average salary of $61K.