Mark J. Lema, M.D., Ph.D. Editor

It’s Nothing Personal, But You’re Fired

The concept of getting a pink slip in one’s paycheck is unthinkable to almost every physician. In fact, society generally believes that having a medical degree is a license for guaranteed employment. Unlike executives and ball players who plan for premature extinction, doctors just fade away. Moreover, being an anesthesiologist in 2003 is second only to being a radiologist when it comes to job security.

At one time, doctors were practically immune to losing their jobs. As hospitals and universities continue to downsize and economize, however, doctors are now vulnerable to layoffs. According to Wayne Sotile, Ph.D., a Winston-Salem, North Carolina, psychologist, his consulting group has seen more laid-off physicians in the past five years than in the prior 20 years.¹

When one hears of a physician being laid off or not promoted to partner status in the medical group, the first impression one has is that of incompetence or incompatibility. However, excellent physicians are now getting caught in the crossfire between institutions and payers. Dr. Sotile states that laid-off doctors “…feel ashamed, like ‘I have failed.’”²

Recent events across the nation confirm an unprecedented change in physician practice security according to a recent article in American Medical News (AMN).¹

1998 – Allegheny General Hospital released several psychiatrists.

2003 – Las Vegas University Medical Center laid off up to 15 physicians.

2003 – Waltham Hospital closed after 17 years, and eight to 10 physicians lost their jobs.

2003 – Detroit Medical Center laid off 1,000 workers, including staff physicians.

Three physicians who are highlighted in the AMN article reveal the emotions that any doctor would feel if notified of being terminated. For physicians accustomed to succeeding, being fired provokes feelings of worthlessness, depression and self-doubt. Each physician in the article stressed the importance of collegial commiseration and family support during the transitional period.

In reality, there is always some location in which unemployed physicians can secure another position. Practically speaking, though, giving up one’s familiar surroundings, established prestige and comfortable practice can be psychologically devastating. In addition, the physician’s family often becomes “collateral damage,” suffering loss of economic security, long-time friends and familiar surroundings. Changing practice and living location ranks high on the Holmes and Raye scale of stressors.

Unemployed qualified doctors are fortunate in that they will almost always find a job. During the “in-between-jobs” period, however, the physician has an opportunity to evaluate what he or she wants in his or her personal and professional life. Most importantly, doctors need to network with their colleagues in order to expand their opportunities. Although salaried physicians are by definition the most vulnerable to termination, contract physicians also can be adversely affected if their main hospital closes or economically decredentials them. Salaried physicians often seek an independent private practice environment to become their own bosses. In most cases, they succeed beyond the point they would have achieved if they had kept their former jobs.

You might think that this article has little if any impact on your practice arrangements. Competing anesthesiology groups in the same hospital are generally rare. “Takeovers” by other groups, once common in the mid-1990s, are stalled because of the anesthesiology personnel shortage. A number of our colleagues, though, may still be subject to dismissal or forced resignation (retirement) by coworkers in more subtle ways than receiving a pink slip.

Should you become a victim of downsizing, here are a few guidelines to help you navigate a rapid change of jobs.

What to Do if Terminated³
• Do not take a layoff by an institution personally. In this business-oriented medical care environment, the bottom line often governs the decision (e.g., closure of an unprofitable pain center).
• Network with colleagues who know you and can vouch for your skills when you are seeking potential job contacts.
• Assess your own strengths and weaknesses or ask a close friend who will provide an honest perception of your assets and liabilities.
• Clarify your professional goals and synchronize them with personal goals. Do you need to work more hours for the increased pay (college tuition), or can you change lifestyles to live within a lower budget that affords more recreational time?
• Consider locum tenens work if you have an interest in traveling or if you must keep your family in the same location where jobs are currently not available.
• Create a career path that is to your liking. Perhaps becoming an academic physician may provide more satisfaction than your previous private practice position.
• Use family, friends, clergy or counselors early in the process to ameliorate feelings of despair and loss of self-worth.

While anesthesiology is enjoying great success in placing graduates and other physicians in satisfying practices in desired locations, let us not forget the not-so-distant past when the perceived surplus of anesthesiologists lowered starting salaries to what new nurse anesthetists earned.

Save this article, file it under JOB-SEEKING INFORMATION, and hope that you never need to reread it.

– M.J.L.

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