Increasingly, physicians today are employed and most of them willingly so. The advantages of this employment model, which I will highlight below, appeal to the current and emerging generations of physicians and medical professionals. In addition, the alternatives to direct employment are scarce, although they do exist. Private practice gastroenterology practices in Cleveland, for example, are increasingly rare sightings.
Another practice model is gaining ground rapidly on the
medical landscape. Private equity (PE)
firms have been purchasing medical
practices who are in need of capital and management oversight. PE can provide services efficiently as they
may be serving multiple practices and have economies of scale. While these physicians technically have
authority over all medical decisions, the PE partners can exert behavioral
influences on physicians which can be ethically problematic. For example, if
the PE folks reduce non-medical overhead, this may very directly affect patient
care. And, it is certainly possible that PE might try to inject influence into
the clinical realm to maximize profits. One can appreciate that medical professionals
and their business partners may have differing agendas. Physicians who choose to enter into these
agreements are strongly encouraged to proceed with eyes wide open and to
solicit professional and legal advice. These
are complex business arrangements that are likely beyond the grasp of most
medical professionals. PE may make sense
in certain circumstances, but physician due diligence is mandatory. And finally, similar to vacation timeshare
purchases, it can be difficult and expensive for doctors to extricate themselves
from PE agreements. In summary, caveat
doctor!
The direct employment model – which describes my own job –
has many attractive features and some drawbacks. Unlike PE opportunities, physician employees
like me have no equity interest. When
our term of service ends, we leave with nothing. Similar to successful PE partnerships, a
physician employer should be culturally aligned with the medical
practitioners. If medical quality is a
shared goal, and the medical staff are fairly compensated, then the prospect
for successful and satisfying employment is maximized. If profits, however, become a priority, then
expect medical burnout and physician and staff loss to occur.
The employed medical professional must accept the loss of
autonomy in making policy, running the practice and hiring staff. This may be a difficult transition for a
physician who formerly was an independent private practitioner. I also feel there are certain personality
types that are not well suited for employee status. For me, in the twilight of my career, I’m not
looking to run anything. The relief of
no longer running a medical business is huge. I don’t spend a nanosecond
worrying about payroll, reimbursement issues, the cost of medical equipment, arbitrating
staff disputes, competition from other GI groups in the community or hustling
for new patients. Of course, no model is
perfect. But in my current job, I can largely focus my time and attention on
practicing medicine. Not a bad gig to end my career on.
Employment sounds great but when you take the check it comes with loss of control. Some physicians can accept that others cannot . Neither of them know how they will react until they actually experience it.
ReplyDeleteI know drs. Say they don’t want to run the business part of a practice. I had a private practice for over 17 and ran all the management, marketing, and employees and all their problems. Then when I went to retire I was able to sell the practice.
DeleteYou have to know yourself. Running your own practice is not hard. But you do have to be entrepreneurial. If you simply want to show up and collect a paycheck then being employed is for you. Conversely if you are looking for upside, opportunity and control that only comes from having an independent practice. If you are at the end of your career and are looking to chill being employed may work for you. Encouraging docs at the beginning of their careers to be lifetime cogs in the wheel with no upside, no exit strategy is short sighted. Many of those docs would thrive if only they gave private practice a chance. We need experienced docs to encourage them and not dissuade them.
ReplyDeleteShort-sighted is the correct description of this article.
DeleteThe outlook for independent practices is bleak as the fee for service model of reimbursement is not in the best interest of insurers, institutional health plans, or the government. Now that majority of physicians are employed, the question becomes whether to unionize or not.
ReplyDeleteSadly, you have nailed it. Now 75% of physicians are employees, perhaps partly becomes so many more female physicians can better predict their work schedule and time for family. A number of new specialties have been created to enables regular hours with no call requirements, marketing needs, dealing with employee issues and the other business concerns. Because these employer entities have begun to realize that there are not many other "different" options, they ask themselves "why pay so much? where can they go" and the downward spiral of pay begins. Now unionization is beginning to be promoted by the AMA and state societies with hopes that they will be the income producing, negotiating entity, since physicians today also have lost the desire to belong to organized medicine, or even to participate in hospital medical staff meetings\functions with loss of control of the "quality" hospital issues, as well as the loss of collegiality, enhanced by the new system removing the need for building a referral source.
DeleteMedical students and residents have little interaction with private practitioners now, so their mentors are employees with no experience with the "business" of medicine, and hence no ability to teach or promote that aspect of medical practice.
A common refrain from medical students and residents is that they know nothing about "business," perhaps excepting those obtaining MBAs, which further promotes the "administrative" world of medicine - not the independent practice model.
For me, also at the end of my own career, I rue the rise of the employed physician. When will employed physicians understand that the goal of the PE company or the employers (who have stock in the company) is to build the company as big as possible and sell it so they can cash out and retire early? They don't give a crap about care, except as it relates to the buy out fee. They are interested in hiring warm bodies. You ultimately lose your autonomy and any possible equity for your hard work. You are a drone. In the 'old' days, you had the ability to be part of something you and your partners were building, and your reputation was based on who you hired and how you ran your practice. In an employment situation, you are a number, and your relationship is transactional. If you complain or leave, it is "next man up."
ReplyDeleteYou are 100% spot on; the rise of the administrative state is what made these changes inevitable and no one, neither patient nor doctor nor employer, are better off for it.
DeletePrivate practice let’s one not just “run “ the practice but also the office flow and day to day people one works with. Also the way things flow is in the control of the provider.
ReplyDeleteUnfortunately the Government and Hospital lobbyists ( no one looks out for physicians ) are negatively hurting private practice in favor of large system approach to care. Once we are gone then complete control of messaging occurs and providers will be dictated to even further. It is and always has been about who controls delivery of care. I hope the newer generation of physicians wake up before it is too late .
The author differentiate between direct employment and PE model. However, in practice, the pitfalls of PE are exactly the same as DE. I observe my colleagues working for the hospital as their support staff get slashed and administrative overseers pile up demanding more and more work. No wonder we have constant rotation of internists, surgeons and other physicians. That brings me to another point, there is no longer commitment to the patients, to practice or community. Just being a cog, nothing else. For example last 5 years, I had to switch 3 different primary care physicians as they kept leaving.
ReplyDeleteCorrect; employment is employment, PE vs large institution is a distinction without difference.
DeleteWorking for hospital systems gives a false sense of security and complacency. I, like you am at the end of my career and therefore more likely to benefit than some of my younger partners in terms of mental stress. However, I caution younger people that the value of your practice will be ZERO when you retire, i.e. you will not have built any equity all the years you have worked. Health systems pay you on an RVU basis but what they pay you is far below what they make on you, and if they are not, they will ratchet down your pay come time to renegotiate your contract. For preceduralists like me, they want us to do do preocedures in hospitals because they get an extrodinary amount of extra money (up to 30% higher reimbursement) as compared to site of service in an ASC or office based setting, even for the exact same procedure. Whether that remains the same with value based care and reimbursement being agnostic of the site of care in the future remains to be seen. If you do go donw the path of joining a healthcare system, then try and get an equity position in something, whether it be real estate, ASC, etc etc that will at least have value when you retire
ReplyDeleteGroups of physicians can start their own "Private Equity Model". You merely set up a practice model that handles all the hassle factors of the "business" and give each MD a piece of the pie depending on how hard they work. If the group is large enough insurance and hospital will negotiate with them. It's time to put patients first not corporate greed.
ReplyDeleteI am close to my possible retirement. I work for county hospital which is also primary teaching hospital for a highly ranked medical school. I always tell young physicians who think about joining our practice to go for own practice or join a group of physicians.
DeleteThat's exactly what I am planning, myself. My partners and I setting up a GP-LP practice model and integrating our specialty with primary care and surgery. We plan to give equity stakes to physicians who join our model. However, our model is based on the venture capital model and give physicians some autonomy.
DeleteThe intrusion of business models into the practice of medicine has eroded the doctor-patient relationship, ended the ideal of continuity of care, and led to the loss of the public’s trust in the medical profession, including recently the resistance to advice about dealing with the COVID-19 pandemic. As a late-career lifetime solo practice psychiatrist, I was blessed to finish residency with no debt and to be able to do things “my way,” including currently working only part-time, only telemedicine, cash only. For young physicians entering practice today with significant debt, they are already not in control, and their top priority will be who offers the biggest paycheck.
ReplyDeleteThe landscape has definitely shifted to direct employee or PE model and away from the self employed model for reasons that are provide for better quality care and economic efficacy.
ReplyDeleteThere are many driving changes but the what is think is most significant is the increasing trend for any illness to require input from multiple specialties, increasing requirement for super sub specialization in the different specialties, need for more advanced and costly equipment. The pouring in of equity money into medical practices have seen practices and hospitals taken over by these corporations and with manipulation of laws and ability to provide more convenience for patients been able to force many independent practices, making the few remaining to have a tough going getting cooperating individual practices. The proliferation of advanced practitioners has also limited the population of patients available for individual private practice as private equity has also used them to gobble up the population of patients that will enable practice of scale. Use of hospitals of hospitalists and surgicalist has even further reduced income physicians individual private practice physicians earn when their patients are admitted and treated in hospitals. I do not know if hospitals are ale to without cause deny a physician privilege to a hospital.
after 34 years in private practice I closed my practice and was offered a part time position at a major medical center as I knew the chairman of the department,who knew me and my work.
ReplyDeleteI was tired of running the practice.Employees were hard to find . I did not want any more call.I was tired of dealing with insurance companies not paying or making it difficult to get paid for what had already been done.
Hippa,payroll,office management,dealing with the different personalities,getting the best rates on supplies,etc.
As soon as I start Ted at the new position I found how inefficient the big center was. Appointments were not managed correctly.Schedulers did not know what the doctors needed.I could not just add a patient to the schedule who needed my services over the ER.I never knew what was charged for my services and what was paid or written off.
Although it seemed like a good idea,my concern is for the new physicians who cannot take care of patients like I did. The y never think to just have the patient come in.
The office administrator runs things to her satisfaction and the doctors have no say.
HOW DUMB,but all the administrators just do whatever it is they do,make decisions without doctor input,and get paid more than the doctors who actually generate the dollars coming in.
I recall a day in 1992 when all the physicians in my town got together to form a group to negotiate with the insurers. I said to the doctor sitting next to me. “This is the end of doctors running medicine” to which he agreed.
Young doctors need to know that they are being controlled by the administrators and PE Firms for profit only.
Doctors do not get paid what they should receive and do or even know what that should be
Private practice may be difficult but it has better rewards,control,patient care,autonomy,as well as the income. It takes work to maintain referrals,satisfy everyone but I would do it again if I had to
If you help to train residents you should try to influence their decision to work in private practice
Thank you for writing about the trend that has been happening for many decades and has accelerated during the Covid era.
ReplyDeleteUnfortunately, patient outcomes and provider satisfaction have declined in the employment model in my opinion.
It is incumbent upon us to change the landscape and offer solutions to private equity and other employment models. I probably have 15 years left in my Family Practice career which has always been self-employed. Over the past two decades, I have joined other independent practitioners to grow under 1 tax id and it’s starting to have a snowball effect which is attracting younger physicians.
We have grown from a 7 provider practice in 2007 to 60 providers and will be merging with other independent practices in January to become a group of 150 independent providers under a new single tax id.
It takes an investment in business skills and leader ship skills, but we are very happy overall. Some of our leaders are very active in legislation to promote prospective payments as it is quite challenging to stay afloat in the current reimbursement model. It also takes significant capital and there are options without taking out significant loans or giving up equity in the private practice .
We may be fighting a losing battle, but the fight is part of the fun :-)
Your comments were almost verbatim for what I was going to post except I was in solo fam medicine for 44 yrs before I joined a large hospital group in Houston. After 3 yrs I retired at age 75 and realized how lucky I had been on my own and not in the employed corporate medicine world all those yrs.
DeleteOutstanding comments and dialogue to my post. I feel the angst oozing from several of your comments. The employment model - as in any model - offers advantages and drawbacks. One persons’s drawback may be another’s advantages. And one’s priorities and interests likely evolve over time. I started my career as an employed gastroenterologist. After a decade, I joined a private GI group where I had a great run for about 20 years. We practiced very high quality specialty medicine but our group had been whittled down to two MD’s and we were unable to recruit new practitioners. We were approached by a rather large physician employer and we accepted very fair terms from them. Now that I am in the autumn of my career, I have different professional needs than I had years ago. I have no on-call or hospital responsibilities - which has been hugely satisfying. I still believe strongly in the private practice model, not only because of the relative autonomy that it offers, but because I believe this tends to provide more attentive and responsive care to patients. Business owners tend to be more motivated to take care of their customers. However, as we all know, private practice opportunities are vanishing so the vast majority of incoming physicians will be employed and many of them enthusiastically. More disruptive than direct employment, will be artificial intelligence which will reengineer our profession and society at large. M. Kirsch.
ReplyDeleteI do not think people should be too surprised at what is happening as capitalism is steam rolling through and all safeguards are thrown out of the window to safeguard capital.
DeleteWhat happened to independent grocery stores and small retail businesses is what is happening to the practice of medicine. Corporations are people my friend and corporate practices are assumed equivalent to independent practices. But on a serious not why should a primary/family care physician, refer a patient to you for colonoscope when there is a GI practice in the same employment system? It is so much easier to set up the appointment and get the patient in without having to make a phone call and also helping his group and corespondent on consult and other recommendations does not have to be sent.
The independent practice is in a death throw and will go the way of the steam engine just as the internal combustion cars will follow in the not distant future. I am not yet able to afford an EV but ill get one if I am able to afford it, but definitely not a Tesla cause the A-hole who has made his name synonymous to Tesla comes across as a disgusting human specimen.
I have watched my friends that had sold their practices to hospitals and became employees with 5 year contracts. At the end of their contracts ,many were terminated and replaced by residents that had recently finished training. All autonomy was lost while being an employee of the hospital and they had to start anew when the contract expired! The hospitals got rid of the higher salaried doctors and lured the new doctors in at a lower pay scale. With restrictive practice covenants many had to leave the area and their old patients remained behind! I spent my first 20 years of my practice with another MD in Internal Medicine and learned not only GOOD patient care but also the business aspects of medicine. We had a fee for service and never participated in an HMO. We were very busy and happy doing what we were trained to do- PRACTICE MEDICINE!!!! My last 26 years of medicine I was in a solo practice and loved every minute of it. I was my own boss and could spend as much time as needed with the patients. Sure the hours were long, but the patients knew that I was only a phone call away 24/7 and they respected this. I had full hospital privileges including ICU and Cardiac Care and took care of all my patients in the hospital. Continuity of care is so important in medicine and unfortunately with business run practices this is lacking! True there are other nonmedical jobs that I had to manage, but my autonomy out weighed this. I spent 46 years practicing medicine and not an employee! Dale V Sinker MD
ReplyDelete"I had full hospital privileges including ICU and Cardiac Care and took care of all my patients in the hospital. Continuity of care is so important in medicine and unfortunately with business run practices this is lacking! True there are other nonmedical jobs that I had to manage, but my autonomy out weighed this. I spent 46 years practicing medicine and not an employee! Dale V Sinker MD".
DeleteContinuity of care matters but one does not have to do it by oneself to maintain continuity of care as first one cannot be there 24 hours a day seven days a week, what is required for continuity of care is proper and thorough transfer of information to the current physician from the previous. Secondly with the astounding amount of current present day information, multiple skill requirements and improvement of skills with practice it is becoming less and less impractical for the single do it all practitioner, and big business has stepped into it and it will never be the same again.
Physicians are ultimately seeking stability and security in these constantly changing times. They also favor situations which do not add to their financial burden and exposure - with training debt being onerous enough
ReplyDeleteIf the AMA, member Boards, specialty societies and medical schools wanted to improve the doctor-patient relationship, stop the unnecessary “pre-authorization” process, eliminate physician burnout and improve access to quality care, they would all be advocating for physicians to stop signing burdensome insurance network contracts. When I started in medical practice, before “managed care”, physician burnout was virtually unknown, and the US medical care was the envy of the world. The managed care system was supposed to eliminate unnecessary surgery, save money, and lower medical costs, but instead we have grossly increased insurance company profits, frustrated physicians, delayed or denied care and assembly line, inaccessible medical care that isn’t even a shadow of its prior self. If this idea resonates with you, look into the American Association of Physicians and Surgeons. They ARE what the AMA is supposed to be.
ReplyDeleteI started as an independent practice patient satisfaction and accounts receivable were excellent, but we lost money on Medicaid and Medicare and the hospital system held the insurance contracts, so we sold out. Initially payments were good but later they dropped. While those in the hospital had their overhead covered when we were on our own, we did not, so leaving became difficult. I missed being able to fix problems and do things efficiently which couldn't be done within a large group. I enjoyed the control of our own practice and the ability to write things off when appropriate. I also knew that if anything happened legally the system would throw me under the bus to protect themselves as I saw it happen. I also was forced to supervise mid levels and bear the responsibility but I couldn't control them, hire or fire them and they weren't very good or well trained, so I retired.
ReplyDelete“ Encouraging docs at the beginning of their careers to be lifetime cogs in the wheel with no upside, no exit strategy is short sighted. Many of those docs would thrive if only they gave private practice a chance. We need experienced docs to encourage them and not dissuade them.”
ReplyDeleteAgree with this. Most of the physicians finishing training now seem unaware that independent practices can still exist in the current environment, if they are willing to assume the responsibilities it entails. In exchange for those responsibilities they will regain equity in and authority over their own future. Employment (where PE or DE) -vs- independent practice is like paying rent -vs- paying a mortgage. At the end of a lease you own nothing, at the end of a mortgage you own the place.
For a group of really intelligent people, doctors can be the worst business people! Truly, running a practice is really not rocket science--there are so many ancillary groups that help small companies with payroll, hiring,
ReplyDeletedisability insurances, HR now- just go to Costco to start. The upside is huge. Make your own decisions, schedule how YOU like and earn 3x what the employees give you. I am not sure why you all went to medical school so people with half your education can deprive you of your earnings and decision making ability.
Well said. There is more to the practice of medicine the equity and profitability. When you have to stop seeing certain patients because you can’t afford the overhead of your practice it contradicts every bit of the hippocratic oath. There are advantages and disadvantages to each type of employment/practice. To each its own.
ReplyDeleteThere are many organizational models now for a medical practice. Those where the physicians have no equity stake in ownership lend themselves to a lack of interest in the success and future of the business. And no matter how it’s set up, it IS a business. The best of patient care requires empathy and a caring attitude and from my experiences, some type of ownership. Large practice roll ups that give equity to physician members accomplish that. It doesn’t matter if there is a private equity partner as long as practices manage their patient care and physicians get more out of the deal than a employee contract and a paycheck.
ReplyDeleteBiblical scholars often interpret the 40 years of Moses and the Israelites wandering in the desert as necessary for the former slaves of Egypt to forget about slavery and the idolatry of their former enslavers. We are now seeing the reverse: managed care started in 1992 and by 2032 there will be no physicians left in private practice (except for some concierge docs in affluent areas). We will be fully enslaved. We should start searching for a new Moses.
ReplyDeleteI love the Moses comment because of the obvious parallels with our medical situation. Moses lead the chosen people out of slavery into the promised land and they griped the entire way. (Sounds like the doctors who choose to continue in the same broken payment system that is causing the problem). The third-party payment model is guaranteed to create a loss of autonomy and financial hardship for doctor and patient. Returning to a direct payment model through Direct Patient Care (DPC), concierge or fee-for-service is the first step to restoring the doctor-patient relationship and ejecting the corporate and government interlopers. (Administrators consume up to 50% of the health care dollar)
DeleteConcierge practice may not be affordable for lower income patients but DPC works affordably for almost anyone who wants access to a primary care physician. These movements are growing without much support from organized medicine and are clearly the start of a trend that should be whole-heartedly pursued by the entire profession if we hope to maintain any degree of autonomy.
Deanne Waldman MD has written a well-referenced short book on an inclusive payment model that he calls "States Care." It may seem like wishful thinking but it looks like one possible way through the desert to the promised land of high quality affordable health care. (https://www.deanewaldman.com/what-is-statescare.html)
Where you start is not going to be where you end up.
ReplyDeleteThe basic interest of the physician and that of management that hires doctors are not aligned...therefore, it is a matter of time before that becomes evident and as the doctor, you no longer have a say...you are an expendable employee. Another adage, there is no free lunch, applys here....
I urge doctors to come up with models that avoids giving over your autonomy to organizations who's basic interest and charter is to make money from your labors...to be very blunt, it is the "laziness" of wanting everything for nothing that leads to this new form of "slavery" where you voluntarily give up your rights/autonomy for temporary relief. In the end, this direction does not lead to good outcomes for either the doctor or the patient.
Be wary and use the "smarts" that we have wisely and avoid this huge pitfall that is coming around the corner...if it is not already here (for many)...remember, you are the one that holds the skills to bring health to the society that you spend nearly a decade to acquire...don't give up when you are almost there.
as part of the practice of the pratice you should also have part ownership of the building or space, so you can have something when you leave to negotiate with,
ReplyDeleteI agree with nearly all said above. After owning my practice for 25 years, I went to work for our small rural hospital which was managed locally, and life as an outpatient PCP wasn't bad.
ReplyDeleteOur struggling hospital was bought by a medium sized corporation 2.5 years ago, and now it seems that administrators outnumber providers. We have a revolving door of PA's and NP's and half as many physicians. I am glad to be close to retirement, though I love serving patients. I will probably do some charitable work after the mortgage is paid off, rather than deal with bureaucracy.
My father summed Big Management up well, "Difficult to get moving, impossible to stop." The up and coming docs will have to make the best of it, dysfunctional EMR's and all.
Employees are nothing but the B$#@$ of the employer. You are taking care of Admin's patients and will do what you are told.
ReplyDeleteI've been studying and researching for the last 22 years in my retirement from medical practice, all the reasons why physicians have been losing their medical practices for financial reasons--because it happened to me. Every bit of research I did pointed to the fact that medical school education in all USA medical schools over the last century have refused to provide a business education while in medical school. Medical practice is a real business. Compare that fact with the fact that universally every highly successful business owners or companies all know what physicians don't know and are never told. That is--- the fact that business management and essential marketing across the world is a mandatory requirement for true success---meaning that, if physicians who have for the last century, without any business education been claiming to be successful in their practice have missed out on the one thing that is proven to effectively enable any physician to earn as much income as they desire, anytime they choose, for any reason, it requires a business education. That bit of ignorance is the cause of the disintegration of private medical practice in our nation and will in a short time let our government control healthcare, the medical profession, and the medical school restriction of providing a business education for all medical students. Now, if you use a bit of logic, if every physician has had a business education while in medical school which could easily be accomplished by providing a digital business education to students to learn from over the four years. Med students at least have to be told the benefits of business education. It is heartbreaking to see so many great and motivated physicians being destroyed because of the single lack of a business education. I'm not applauding a two year business education on campus for $40,000 nor even an MBA, which is useless for physicians. What I am sure of, is that a business education can be learned without stopping medical practice, is very easy to learn, and digitally would cost about $2000.00 to learn at home online. I have created a website for teaching physicians what they need to know, the only one in existence today online. The thing is that it is a hell of lot easier than learning all the origins and insertions of every muscle in the human body and you don't have to learn everything--you can skyrocket your management and marketing skills by using one or two strategies--not all of them. And you can be your own boss and in control of your career destination. You may have noticed that no one in the medical world has found a way to relieve the burnout, disappointment, making income by seeing more patients, among all the other abuses you have to put up with. The backup of a medical practice business education is available---you just haven't found out yet. If you'd like to know, then find me online and we will talk.
ReplyDeleteEmployed MD's are one of the most dangerous trends today. The loss of the independent MD jeopardizes the patient/physician relationship-after all- the Health System view is that you're an employee and are to do what we set as protocol-the key to your existence is to provide referrals-nothing more-nothing less. We as patients we lose-and we ALL will be patients at some point. Health Systems (hospitals) are not patient focused-they are revenue focused-not many have a balance between patient care and revenue. Control-inefficiency-self serving-power grabbers define many Health Systems. I use to think when you worked for an insurance you turned to the Darkside-I now think it's when you've become an employed Physician. How do I know-I was a "Suit" for a long time.
ReplyDeletePhysicians now have resources that were not available 10 years ago-paying appropriately-diligent oversight-understanding basic (P&L-Balance Sheet-Revenue cycle, checks and balances) business principles will make "running" a practice a good experience and keeps your patients safe for most of the "Darkside". A good consulat is work their fee!
I have owned and managed my own family practice very successfully over the past 33 years. As I read through the comments I find it very interesting that personal lifestyle is not addressed more prominently. Do I enjoy the autonomy and personal satisfaction of running my own practice? Of course. Do I enjoy working dawn till late evening every day keeping on top of the ever expanding data manipulations and charting? Do I enjoy having the small amount of time I spend with my wife at dinner interrupted by my answering service? Do I enjoy only being able to spend 1 week vacation a year away from my practice before it implodes despite hiring excellent office managers and NPs? Absolutely not. The constant oversight needed is the downfall of independent practice. The graduates today do not share the same work ethic as many of us here from prior generations. To all those physicians who want to "educate" the new grads on the virtues of independent practice, I would say they already know. They choose a better work/life balance as an employed physician and eschew our lifestyles. And I don't blame them. I have had a rewarding professional life as I look back however were I to do it again, perhaps I would devote more time to my wife and family.
ReplyDeleteExcellent comment above lay it all out in stark and reasonable terms. I agree that the emerging generation of physicians has looked at how we did it and concluded that they don't want it for them.
ReplyDeleteThe author didn't mention another alternative that supplies the best of both worlds: a large, physician-owned medical group where the CEO and admin staff are all hired by the physician-owners and who serve at the doctors' pleasure. I am part of such a primary care group in east Tennessee, and I can't praise our group enough! I practice alone in my little office and have complete control over it all, but I have the resources of a large and excellent staff including IT & financial & business & legal & HR folks.
ReplyDeleteI do the work and take home whatever I earn. I pay the admin staff, of course, but the lack of headache and lack of top-down control & influencing is wonderful!
If you are a private practice specialist, you could have unlimited patients IF YOU DO THESE FOUR THINGS!
ReplyDelete1. allow the referral physician's office to call and get an appointment for a patient while they are in our office so we can make sure they are adequately taken care of
2. see patients yourself and do not use an unsupervised NP or PA
3. sent timely reports to the referral physician
4. BE NICE to the patients
(and if you are anywhere near the Spartanburg/Gaffney, SC area, give me your name because I am looking for private practice docs who still care)
You can say that again, Sister! AGREE!
DeleteThis comment has been removed by the author.
ReplyDeleteSo I have been in both models and while I hear all of the wannabe saints in private practice talking the usual nonsense they leave out a whole lot. Here are a few delusions they have. Private doctors think they provide the best care. False! They are often not up on the literature and if they own a surgicenter or infusion center I can assure their goals for care revolve around facility fees and not what’s best. There’s a GI group with such outdated scopes it’s no wonder they have so many interval cancers develop. I’ve been employed by groups and the buy in process, pay, and restrictive covenants are way more unfair than employed positions. There’s no perfect job but these fossils eschewing the virtues of private practice are ignorant to their own biases. I see a lot of “yes men” in private practice as well. Doc A thinks patient X needs surgery. They send to surgeon Y who disagrees. Their feelings get hurt so they refer to doctor S, the yes man who will do anything to please so as to not lose referrals. Sound familiar??? Where’s the virtue there? And I have seen this across multiple states and cities so please spare me the “Oh that’s an isolated event “ nonsense. Doctor greed is the reason private practice is dead not corporate medicine. Doctors screwing doctors for money is the norm and doctors have been played.
ReplyDeleteI am an Orthopedic surgeon who turns 70 this August. To my primary care colleagues; yes I was blessed with acceptance to an American medical school, a great Residency and
ReplyDeleteSports Medicine Fellowship. I was also fortunate to be the 3rd physician into a doctor owned practice that grew exponentially before being sold in 2020 to a large hospital network. I stopped call in 2016, have a scribe and an NP who now sees my post ops and her own patients. After 34 years I am leaving this corporate health network in 5 days to explore the world I have observed. from a distance . I have also been blessed with my wife and best friend for 42 years who navigated our family when career demands drew me away. Our 3 professional children know quite well who was the anchor at home.
I did 51surgical cases last month thus leaving on a high note. I am not being 'walked out'; a scenario that I have witnessed too often.
I will miss my staff but most of all my patients who trusted me with their care. I will not miss the layers of administration who have made delivery of superb care and patient satisfaction next to impossible. I plan to transition into volunteer Orthopedic opportunities including overseas, ski and golf with my 4 grandchildren and write creatively; something I have not done in 40 years.
Such a helpful post! Healthy habits like eating whole foods, staying active, and practicing mindfulness are all essential for long-term health.
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