Surgeons Joining the Ranks of Traveling Salesmen

Over a year ago, I commented upon the phenomenon of the physician as traveling salesmen for hospital systems. I noted how physicians spend increasing time between facilities as hospital systems expand, but at the cost of becoming commodities in larger health care systems as they find they must rely on others to deliver care when they are elsewhere.

The hospitalist movement is not much different these days for general internists, as they relinguish their patient's care to others while they are in acute care hospitals. The difference in this model, though, is that doctors can still maintain their identity in their workplace.

Today in the Wall Street Journal, we find that general surgeons, the "primary care" of surgery, are now finding that declining or flat insurance payments, paired with ever-increasing overhead (like office staff and malpractice) have had to resort to folding their practices and traveling to hospitals in need of their expertise in order to survive:

Now the economic and cultural forces reshaping U.S. medicine are prompting an exodus from this once venerable field, creating a growing market for temporary surgeons-for-hire.

As a general surgeon in her hometown of Franklin, Tenn., Jennifer Peppers could no longer keep her practice going after eight years in business. Faced with rising overhead costs and declines in reimbursements, she and her partners stopped drawing salaries last winter. To pay her home mortgage, Dr. Peppers had to borrow from a credit line.

So the surgeons shuttered their practice, and Dr. Peppers, 42 years old, hit the road. Her typical month might now include a weekend in Springfield, Ore., removing ruptured spleens or repairing obstructed bowels, followed by two weeks at a rural Kentucky or New Hampshire hospital. Though she misses her husband, she earns double her old salary and has paid off a big chunk of her medical-school debt. "I'd much prefer to be in my hospital in my little town," says Dr. Peppers, who is now licensed in five states. "But I don't see how that's possible."

While some think this trend might be sustainable, life will eventually catch up with this model, since I believe work-place identity and gratification play as big a role of physician retention as salary, if not more.

-Wes