Hospitals Use Their Medical Schools, Residencies for Later Physician Recruitment

There is a major trend now occurring with young physicians seeking salaried hospital positions rather than entering private practice (see: More Doctors Giving Up Private Practices; The Increasing Tempo of Physician Practice Purchases by Hospitals). The number of hospitalists is exploding (see: Father of Hospital Medicine Has Mixed Review 15 Years Later). Here's a quote from this article about hospital medicine:

Hospital medicine is entering a new growth phase that will capitalize on what it does best, "providing a brand of service and value," according to its founding father, Robert Wachter, MD, ...who established the specialty some 15 years ago....The exponential growth of the specialty was a surprise to many. In 2003, 29% of US medical centers had hospitalists; by 2009, the number had increased to 61%. From 1996 to 2003, the number of hospital medicine physicians was 12,000. As of 2009, there were about 27,000. At this time, hospital medicine is the fastest-growing physician specialty.

I asked the dean of a major medical school recently about how the school and its teaching hospital were accommodating to this trend. He said that they were well positioned to recruit the most talented hospitalists in the future because they could observe their medical students and house officers over time and select the best of them for subsequent job offers. He added that this explains, in part, the impetus for hospitals across the country to launch medical schools and increase their numbers of post-graduate trainees: they are seeking the means to ensure an adequate supply of well-trained physicians in the future.

For me, this was a very insightful comment. I always assumed that most of the impetus for developing new medical schools and expand residency programs was related to the prestige associated with teaching hospitals. However, it's important to factor into this equation the emergence of what I referred to in a previous note as Big Medicine (see: Physician Private Practice Declines; the Last Barrier to Emergence of "Big Medicine"). Here is a quote from this note:

We are witnessing the emergence of what a recent article in the New York Times called Big Medicine ....Simply put, it consists of the following triad: (1) Big Pharma, (2) Big Payers (i.e., the U.S. government and large insurance companies); and (3) Big Providers (i.e., large consolidated regional health systems).

The rapidly growing health systems will soon be delivering healthcare on an unprecedented scale to the majority of the population as the private practice of medicine atrophies. Physician staffing will become a choke point for growth unless a steady stream of well-qualified physician candidates for salaried positions can be assured for hospitals. This is particularly true for hospitals located in less-sought-after cities and regions.