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Health Care Costs and Financing

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Turnover of primary care physicians during the last two decades was common and costly

Health care market forces are quickly driving primary care physicians (PCPs), once largely individual entrepreneurs in private practice, into group practices and salaried positions with health maintenance organizations. For instance, 48 percent of PCPs involved in patient care reported being employed in 1995 compared with only 23 percent in 1983. PCP turnover is a problem, with managed care organizations experiencing a shortage of PCPs as early as 1992. In fact, in 1991, slightly more than half (55 percent) of all PCPs surveyed nationally had left the practice in which they had been employed in 1987, according to a study supported by the Agency for Healthcare Research and Quality (HS08984).

Over one-third of this nationally representative group of PCPs who were leavers (20 percent of the whole sample) had left two employers in that same 5-year period. Mean recruitment and replacement costs for individual PCPs for the three specialties studied were $236,383 for general/family practice, $245,128 for general internal medicine, and $264,645 for pediatrics. Turnover costs for all PCPs in the surveyed group by specialty were $24.5 million for general/family practice, $22.3 million for general/internal medicine, and $22.2 million for pediatrics. Turnover costs for all PCPs in the group studied totaled over $69 million.

Research into PCP job satisfaction and turnover thus far does not point to simple solutions, notes Sharon Buchbinder, R.N., Ph.D., formerly of Johns Hopkins University and now at Towson University, and her colleagues at the Schools of Medicine and Public Health at Johns Hopkins and the Greater Baltimore Medical Center. The researchers analyzed data from two national PCP recruiters and one national survey of physician compensation and productivity to estimate the costs of PCP turnover. They concluded that turnover of PCPs causes health care institutions to lose large investments in human resources, commit resources to their replacement, and increase the salaried labor costs of health services organizations.

See "Estimates of costs of primary care physician turnover," by Dr. Buchbinder, Modena Wilson, M.D., M.P.H., Clifford F. Melick, Ph.D., and Neil R. Powe, M.D., M.P.H., M.B.A., in the November 1999 American Journal of Managed Care 5(11), pp. 1431-1438.

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