Commonly I get calls from allergists wanting to find an associate or looking to sell his or her practice. I hear the same complaint from all of them – I can’t find anybody; no one is interested. In many cases, it is because the young allergist does not want to deal with the business of taking over a practice or is just not interested in a track to partnership. Which begs the question – is allergy a career or a job?
Some interesting insight into the changes in medical practice in the US were published by the AMA in May 2017 as part of their Physician Practice Benchmark Surveys. This data was obtained from a nationally representative assessment of 3,500 American physicians. The major finding of this survey was that physician ownership dropped below 50% for the first time in 2016. This was about 6% lower than in 2012. The percentage of physicians who were employees in their practices increased from almost 42% in 2012 to 47% in 2016. Not only was 2016 the first year in which the owner percentage dipped below 50%, it was also the first year when there were an equal number of employees and owners.
You would probably not be surprised to hear that younger physicians are less likely to have an ownership stake in their practices than their older counterparts. In 2016, ownership ranged from almost 28% among physicians under the age of 40 to almost 55% among those aged 55 and older. Younger physicians were more than three times as likely as older ones to be employed by hospitals. 14% of the under-40 group were direct hospital employees, compared to only about 4% of physicians aged 55 and older. Unfortunately the survey did not break down allergists as a separate category, but my guess is younger allergists are not being employed by hospitals in as high numbers as those in other specialties, since hospitals have not been major buyers of allergy practices.
Other interesting gems mined from this survey:
- Single-specialty practice remained the most common, and accounted for almost 43% of physicians in 2016.
- Only 16% of physicians were in solo practice in 2016, lower by almost 2 percentage points from 2012.
- Although most physicians still work in small practices – almost 58% in practices with 10 or fewer physicians in 2016 – the long term-trend toward larger practice size continued over the 2012 to 2016 period, albeit slowly.
So let’s get back to our original question: Is allergy a career or a job? I believe we are seeing a major shift in the entire field of medicine, not just in allergy. For the younger physician, medicine is now a job. They want larger practices with more predictable income as an employee. They are not interested in the entrepreneurial responsibilities involved in owning a practice. Many have major student loan debt and don’t want to take the financial risk of starting or buying a practice or even getting on a partnership track. They want a better work-life balance than what they see in older physicians. I know many senior allergists don’t understand why allergists coming out of training programs today view allergy as a job. They feel that working 80 hours a week and on call all the time is what you should do if you are a physician.
Well, I am an older physician myself (Medicare is just six months away), but I believe the allergists coming out of training now are correct in looking at allergy as a job. Of course, they want to give compassionate care to allergy patients, but they also understand the importance of family and friends. Look at the burnout rate in medicine; look at the divorce rate in medicine. A change in thought about allergy as an occupation is needed. Yes, allergy is becoming a job and that is OK, as it is a great job.
Michael Blaiss, MD, FACAAI, Executive Medical Director