Are employed physicians less committed?

At this juncture, there's no question that, for various reasons, hospital employment is becoming increasingly popular among physicians. Despite the benefits the employment model offers physicians and the potential opportunities integration provides to close gaps in patient care, comments from doctors who've bucked the hospital-employment trend have been vocal about the downsides.

One disturbing accusation, in particular, seems to run through many of the older generation's criticisms of physicians who agree to work for someone else--a lack of commitment.

While it has become commonplace to hear senior physicians complain about the younger generation's lack of willingness to work the long hours and make the personal sacrifices they did, a sampling of comments from private practice advocates suggests the issue goes deeper, insinuating that many of today's physicians simply aren't as devoted to their organizations, their communities or even their patients.

Consider the following quotations from recent newspaper articles on the subject of physician employment:

"When a physician is in a town, and is committed to that community, his customers, his patients, he's in there for the long haul and invested in the thing and he plans to stay there a long time, as my cohort of physicians did," Dr. James Crichton, a retired physician and former chief of medical staff at St. Peter's Hospital in Helena, Mont. "It's a different situation when you're employed by a hospital and your main customer's the hospital.

"[If employed] You get disgruntled about something [and] instead of saying, ‘Well, I'm committed to this thing, I'm going to see if I can make it better somehow,' you say, ‘Hell, I'll just go,'" Crichton added. "It's lack of commitment, but we have a society where lack of commitment is found just about everywhere you want to look."

"My son and I had deeper feelings for our patients than I think Kate [Dr. Kate Dewar] will ever have," Dr. William Dewar II, the first of three generations of physicians, told the New York Times about his granddaughter's decision to take a job as a salaried emergency room doctor. During the interview at a diner in Honesdale, Penn., Dr. William Dewar III gestured toward the diner's owner, and told the reporter, "I've had three generations of his family under my care. Kate will never have that."

"Right now, [Dr. Jean] Justad and I have a great little clinic," Dr. Jay Larson, a longtime internist who was once employed by a hospital, told the Helena Independent Record. "We focus on patients. That's what it's all about. That's what people want. They want to feel cared for, they want to make sure the person taking care of them is their advocate, and is going to recommend the best thing for them."

But it's not all criticism--with or without a hint of jealousy--that longtime physicians are expressing toward doctors embracing newer, less demanding practice models. There's also a sense of loss for what newer generations might miss. "I loved my practice. Totally loved it," Dr. Kate Dewar's grandfather told the Times about the practice he started 67 years ago. "You were in touch with the patients. They were part of your family."

The tradeoff, of course, is that employed physicians have more time to commit to their own families. As a Gen-Xer myself, I'd argue that physicians who seek more work-life balance do not suffer from a character flaw that makes them less capable of commitment, but simply a different hierarchy determining what they're willing to sacrifice. But I want opinions from those of you working in medicine. Is it possible for physicians to compartmentalize career and family and succeed at both? What are the implications for patients? - Deb