Most medical residents prefer hospital employment in urban areas, survey shows

Most medical residents are interested in practicing for hospital systems in metro areas, which will exacerbate staffing shortages in rural communities, new survey data show.

Nearly half of 103 final-year medical residents surveyed preferred to work for hospital systems, while only 10% wanted to partner with another physician, according to Merritt Hawkins’ April poll. That marks a drastic shift from the staffing firm’s 2011 survey, when almost an equal share of residents preferred hospital employment versus partnering with another physician.

“Most residents don’t want to deal with the hassles of running their own business. The path of least resistance is being employed,” said Tom Florence, executive vice president at Merritt Hawkins. “The share of residents who would prefer to hang their own shingle in an independent practice model is dwindling. Some will look to join a group or be a partner, but being a solo practitioners is not very desirable at all.”

Around 30% of residents said they would prioritize joining single or multispecialty physician groups, but only 1% said they preferred to go solo. Hospitals, health systems and larger physician practices typically have more robust IT and data analysis tools, easing doctors’ administrative burden related to electronic health records, claims and quality management.

That mirrors recent American Medical Association data that found that around 49% of doctors worked in a private practice in 2020; that share was 60% in 2012. Almost 40% of physicians worked directly for hospitals or practices at least partially owned by hospitals in 2020, up from 29% in 2012, the AMA found.

“There has been a defining shift in the way healthcare services are organized and managed,” Gary Young, director of the Center for Health Policy and Healthcare Research at Northeastern University, told Modern Healthcare last week. “Vertical integration represents one of the most important changes in how healthcare services are delivered, and we need to pay attention to the implications.”

Residents also preferred larger cities over smaller communities. More than three-quarters of residents would prefer to practice in a community of 100,000 people or more, with most vying for cities with 1 million-plus residents, Merritt Hawkins found.

“Rural communities are still struggling to find primary-care physicians and specialists,” Florence said, adding that he tells his clients in rural areas to consider telehealth and the H-1B visa program for high-skilled workers, among other options. “Lifestyle is one thing. It also takes a special candidate to be in rural areas. They have to be confident in their abilities and not require as much help because you have to wear several hats.”

More residents are pursuing higher-paying specialty roles over primary care. Less than a third of residents were studying primary care, down from 50% in 2019. Meanwhile, a quarter were specializing in surgery, up from 15% in 2019. There was also more interest in internal medicine subspecialties and diagnostics.

That transition has led to a primary-care shortage. Nurse practitioners and physician assistants are closing that gap, but not entirely, Florence said.

While there was an estimated shortage of 20,400 primary-care physicians in 2020, the supply of NPs and PAs grew by 30% and 58% respectively, outstripping a 17% increase in combined demand, according to the Health Resources and Services Administration.

“There is still going to be a shortage of primary care; advanced-practice practitioners are helping but not totally offsetting it,” Florence said. “Rural communities still have a need for primary-care physicians and have a heck of a time finding candidates.”

Family medicine had been the most-recruited specialty for the past 14 years, according to Merritt Hawkins data. That changed last year as demand for nurse practitioners outpaced family physicians, Florence said, noting that transition partly stems from APPs’ growing role in healthcare.

While female residents are more heavily recruited than their male counterparts, they expect to earn less as they battle systemic gender biases.

Regardless of gender, most residents said they weren’t equipped to handle the business of healthcare. Only 10% were “very prepared,” while 58% were somewhat prepared and 32% were unprepared, according to the survey.

Most didn’t receive formal training on contracts, compensation, reimbursement and other employment issues.

“Very little about real-world practice is taught in internal medicine residency,” a resident wrote in the survey. “The patient caps, the daily grill, unable to make independent decisions and suddenly when I am the only person between the orders and the patient it is a bit nerve wracking. There is also concern regarding different practice regions: some places want you to do some procedures, while some others don’t. During residency we don’t do much procedures. We call consults for simple stuff but many hospitals might not like that.”


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