By Raj Sawh-Martinez, MD, Lin Lin Gao, MD, and Chad Purnell, MD
Perhaps more than ever before, it has been suggested that the current generation of residents “aren’t what they used to be.” With work hours restrictions and major changes to healthcare such as new satisfaction and quality metrics, the experience of being a resident has certainly changed. At the same time, career priorities and perspectives change throughout a lifetime. Finding the right balance of lifestyle, compensation and work mix is a dynamic and personal journey faced by all young employees entering the workforce. Preferences and priorities of both surgeons in practice and trainees remain unexplored. In their article in the July issue of PRS, Koltz et al investigated these priorities and sought to determine the overall satisfaction level of practicing plastic surgeons, if and why they changed jobs, and what factors residents considered in choosing a position. In this post, we will discuss some of the interesting points raised in this article.
Are resident priorities different than their senior colleagues? The article certainly highlights a discrepancy between the reality of the majority of attending employment mix, and senior residents’ desired employment. While 43% of responding attendings were in private practice, only 19% were in private practice with a clinical appointment. Almost triple that amount, 55.8% of senior residents, desired to be in private practice with a clinical appointment. Interestingly, senior residents reported a preference for location, case mix and a desire to teach over earning potential and incentive structures as compared to those currently in practice (Table 1). This might represent changing priorities for this generation of residents, but it could also be due to the inexperience of residents, who have been sheltered in academia throughout training, and may not be aware of the realities of practice economics. It seems that it is more likely that these differences represent a slow change in priorities as one’s career progresses. Junior attending responses were closer to that of residents, as compared to those of senior surgeons. Are these junior attendings part of a newer generation with differing priorities, or are they in the early phase of their maturation process?
It seems from the article that the search for the perfect job doesn’t often end with a surgeon’s first position. Koltz et al found that 39.2% of board-certified plastic surgeons changed their employment; of these, 50% of these went from one private practice to another and 27.4% changed from academics to private practice. Not surprisingly, those in academic practice were more satisfied with their case mix, but less satisfied with their incentive structure and payer mix. This illustrates the trade off between being in academics with a desirable varied caseload, but a less desirable compensation compared to being in private practice. Interestingly, a vast majority of plastic surgeons either remained in, or switched to private practice, but far fewer switched into academics. Are private practice surgeons truly more satisfied, or is this because there is little opportunity or incentive to take on additional responsibilities, such as teaching or publishing once one has become an established plastic surgeon? Or, is the allure of greater personal control over a practice operation driving the shift away from academia?
Priorities also differed among those who changed jobs versus those who didn’t. The former group valued salary, learning potential and incentive structures while the latter group valued lifestyle, location and desire to teach. Desire for better compensation is a strong motivator for job change, which may drive the transition from academics to private practice.
The article is intriguing for both practicing surgeons and residents alike. It compares and contrasts the value systems of those in practice, those who changed jobs and those who are looking for their first job. As residents, the article provides a glimpse into the priorities of our experienced forerunners, and what they deem to be important for job satisfaction. Studies on human happiness show people are actually poor predictors of how satisfied they will be in the future after they achieved a certain state (winning the lottery, buying a new house, getting a new job). A more accurate representation of how happy a person will be is gathered from those who are already experiencing that state. Even after finally getting that first job as a plastic surgeon, there may still be something missing. The desire to graze on “greener pastures” drives many to change from their initial position.
This timely manuscript raises many more questions than answers. Will reimbursement strategies in academics become more flexible? Will positions incorporating private practice with clinical appointments increase given the demand? Is a 40% employment change rate acceptable? What are the right criteria for choosing that all-important first job, that we will have as we prepare for our board certification? And finally, do current residents truly represent a change from past generations, or will our preferences change as our experience builds in the realities of clinical practice?
Join in on the discussion and add your voice to the great discussion this manuscript from Koltz et. al., has generated in PRS!
|Avg Rank||Avg Rank|
|Guaranteed Salary||4||Opportunity for practice growth||4.4|
|Practice personalities||4.4||Practice personalities||4.7|
|Opportunity for practice growth||5.1||Time frame of guaranteed salary||5.3|
|Exact case mix desired||5.1||Lifestyle||5.6|
|Earning potential||6.4||Earning potential||6|
|Time frame of guaranteed salary||6.5||Exact case mix desired||6.2|
|Exact payer mix desired||8.3||Exact payer mix desired||8.4|
|Desire/lack of, to teach residents||9.8||Desire/lack of, to teach residents||10.7|
Adapted from Koltz, P. F. et al. Employment Satisfaction in Plastic and Reconstructive Surgery and Its Influence on Graduating Residents in an Evolving Health Care Climate. Plastic and Reconstructive Surgery 136, (2015).