Hospital or Private Group?

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I am a new pain fellow who has been casually exploring job opportunities over the past year. Based on my conversations with various groups as well as physician recruiters, the current employment trend for new fellows seems to be towards hospital based practices.

In general, I've seen hospital based practices offer more lucrative compensation packages (salary, signing bonuses, loan repayment), benefits package (malpractice with tail, health insurance, more vacation weeks), and overhead coverage.

However, the scope of practice seems to be less restrictive in a private group setting. For example, some hospitals won't let pain docs perform vertebroplasty or pump implants. These are done by radiologists or neurosurgeons respectively. Personal job satisfaction and financial rewards, with time and effort, may be essentially limitless in private groups. Limited only by the investments you make in your practice and your work ethic.

Do you have any thoughts on the above? I am especially interested to hear the opinions of those who have worked in both settings.

i puzzled over this question a lot a few years ago. i ended up joining and taking over a hospital group, so i am coming from that perspective.

joining an established group initially is very beneficial if you are thinking of the increased financial benefits of doing PP.

what i came up with...

In favor of PP:
1. Much greater financial rewards.
2. Ability to choose what patients you want to see (i.e. good insurance, patients previously not on opioids, etc.)
3. Noone to tell you what you have to do.
4. Can decide what procedures you want to do
5. You get to choose your hours, how you want to work.

In favor of hospital based:
1. Less financial risk
2. Better benefits, such as health insurance, life insurance, etc.
3. Guaranteed pay
4. More likely to have structured hours, and worry less about overtime.
5. Less stress about where to find the next patient.

hospitals also can offer you a 403b plan and sometimes a 457 plan (if the hospital is affiliated with you state. thats an extra 34k/year that is tax exempt on top of whatever you put in your 401k. also, many have legal insurance plans to use for setting up wills, real estate, divorcing your wife, etc. just sayin....

http://www.washingtonpost.com/busine...bwW_story.html

Hospital also offers you the benefit of a CEO who thinks you are there strictly to improve the hospital's bottom line, and any deviation from that is dealt with quickly.

Hospital admins masturbate to thoughts of high Press-Ganey Scores, and if you don't earn them, they will torture you.

Hospital admins see you as a commodity, and will treat you like one.

[QUOTE=PMR 4 MSK;12858705]

Hospital admins masturbate to thoughts of high Press-Ganey Scores, and if you don't earn them, they will torture you.

QUOTE]


is there a website for that? my wife tracks my browsing history so that could get the job done for me.....

concur with PMR 4 MSK!!!

I started as Hospital employee, then moved to a group practice, and finally to owning my own practice.

No question in my mind that I would not want to work for a hospital again.

Originally Posted by PMR 4 MSK

Hospital also offers you the benefit of a CEO who thinks you are there strictly to improve the hospital's bottom line, and any deviation from that is dealt with quickly.

Hospital admins masturbate to thoughts of high Press-Ganey Scores, and if you don't earn them, they will torture you.

Hospital admins see you as a commodity, and will treat you like one.

i was trying to be unbiased...

i definitely thought about those issues, and still do.

in exchange for dealing with the above crap, i dont have to drive around to small crappy doctors offices, trying to schmooze, be nice to "doctors" and "noctors" who believe that the only better thing than 10 percocets a day is 12, and then demand you take over their scripts if you want to continue to see their patients. i dont have to kiss up to some neurosurgeon whose only goal in life is to cause arachnoiditis. i dont have to worry about my car or house being repo'd, of having to panhandle to get patients, of having to do procedures on patients because they are able to pay. and if i take a 2 week vacation? i dont worry about my next paycheck being nonexistent.

face it, we are all screwed.

Originally Posted by PMR 4 MSK

Hospital also offers you the benefit of a CEO who thinks you are there strictly to improve the hospital's bottom line, and any deviation from that is dealt with quickly.

Hospital admins masturbate to thoughts of high Press-Ganey Scores, and if you don't earn them, they will torture you.

Hospital admins see you as a commodity, and will treat you like one.

AMEN! Can i get a witness.

Originally Posted by AirBubble

I am a new pain fellow who has been casually exploring job opportunities over the past year. Based on my conversations with various groups as well as physician recruiters, the current employment trend for new fellows seems to be towards hospital based practices.

In general, I've seen hospital based practices offer more lucrative compensation packages (salary, signing bonuses, loan repayment), benefits package (malpractice with tail, health insurance, more vacation weeks), and overhead coverage.

However, the scope of practice seems to be less restrictive in a private group setting. For example, some hospitals won't let pain docs perform vertebroplasty or pump implants. These are done by radiologists or neurosurgeons respectively. Personal job satisfaction and financial rewards, with time and effort, may be essentially limitless in private groups. Limited only by the investments you make in your practice and your work ethic.

Do you have any thoughts on the above? I am especially interested to hear the opinions of those who have worked in both settings.

Just went through this and settled with a multispecialty physician owned group. Much more autonomy than a hospital employee position, but a lot more financial and referral support than solo practice. Having been a defacto hospital emloyee before fellowship, I agree with PMR 4 MSK. Hospitals will treat you like a highly paid burger flipper. I've seen docs fired for little good reason. I think this trend towards doctors going to employed positions will backfire immensely and start reversing in several years. I personally know several doctors who a couple years ago sold out to a hospital and were promised the world. The offer looked good initially, then once they got them and had them by the you-know-whats they started to treat them like dirt and fired the docs who didn't fall in line. This included experienced trauma surgeons, guys that had been attendings for 20+ years. It was brutal to watch and brutal to have the boot to my own throat. I thank God every day I'm out. Want to see lots of Medicaid? Want to be chastised over patient complaints that have no merit and that if you discharge your most horrendously offending patients that you better stop and "keep them happy" because you are turning away too many "customers" and making the hospital look bad ? Want to be told your hours are going to jump from 40 per week to 60 or 70 hours per week indefinitely until they can replace your parter they just fired? Go work for "the man". Be very cautious.

Could people chime in on how VA compares to hospital based. Wondering if it is the same?

Originally Posted by kstarm

Could people chime in on how VA compares to hospital based. Wondering if it is the same?

VA is not malignant but the pay is lame and stagant. There are lots of useless meeting with useless attendees who get paid to be useless and annoying with no one scrutinizing your time or the bottom line. You can't beat the job security and malpractice coverage at the VA.

If you are the type who wants to clock in and get a paycheck and you value job security >>> ambition, VA is a good place for you.

But if you have any dreams of having an efficient office under your control, with reward and punishment based on your performance and prowess, these dreams will slowly die (painfully) if you are working for the VA.

First of all, thank you for your insightful responses.

The "eat what you kill" philosophy offered by some groups sounds stressful and potentially overwhelming to a new provider with no patient base. I think base salary plus productivity incentives would be fair and reasonable. I'm seeing both and wonder if the former should be considered a "red flag"?

Originally Posted by AirBubble

First of all, thank you for your insightful responses.

The "eat what you kill" philosophy offered by some groups sounds stressful and potentially overwhelming to a new provider with no patient base. I think base salary plus productivity incentives would be fair and reasonable. I'm seeing both and wonder if the former should be considered a "red flag"?

The perspectives that people have voiced are pretty accurate.

The one issue about being hospital based (that's wht I am) is that you are still an 'employee'. Dont get me wrong, the payis a lot more upfront and great benefits but then you have restrictions set down by admin. You are not paying the RNs so there's always that to contend with. If you have great RNs then you are good, if not, your life will be miserable and feel like residency/fellowship.

I wish the PP offerred great salaries, sign on bonuses, then fellows/new grads would have flocked over to PP and hospitals wouldnt be so attractive. Unfortunately, some PP docs were 'greedy'. So now new grads are flocking to hospitals and pretty soon PP could go bust. I wish the PP docs would really be more welcoming and reward their younger colleagues better upfront. Then PP would be more attractive for the young grad/new grad.

Also keep in mind that if you work for a hospital any moonlighting (has to be approved by them), depositions, and any other 'work' you do the hospital gets a cut !!!

So while it looks great at first sight, just be aware.

Originally Posted by AirBubble

First of all, thank you for your insightful responses.

The "eat what you kill" philosophy offered by some groups sounds stressful and potentially overwhelming to a new provider with no patient base. I think base salary plus productivity incentives would be fair and reasonable. I'm seeing both and wonder if the former should be considered a "red flag"?

This is the mentality of many "new" grads. They are scared, tired,came beaten down, so they think I will work for someone and make one good money ( the mentality is, "even the money isn't so great, it's way better than What I made in residency...") and not stress out to hard...

I understand these feelings but think you are selling yourself short. I worked for a hospital, nd was abused and taken advantage of, and now I work for me, and I do the abusing and advantage taking hahah (not really)

If I could do it again, I would go to work for a small group in a place you don't plan to stay, learn everything you can, learn how to bust your ass, learn how to practice ethically but efficiently, then I would bolt and set a partnership close to my house with a dude I know who is like minded and is business savy and trustworthy. But hey, life ain't perfect.

Hospitals are not your friend.

Solid assessment

[QUOTE=PinchandBurn;12861680]The perspectives that people have voiced are pretty accurate.

The one issue about being hospital based (that's wht I am) is that you are still an 'employee'. Dont get me wrong, the payis a lot more upfront and great benefits but then you have restrictions set down by admin. You are not paying the RNs so there's always that to contend with. If you have great RNs then you are good, if not, your life will be miserable and feel like residency/fellowship.

I wish the PP offerred a great salaries, sign on bonuses, then fellows/new grads would have flocked over to PP and hospitals wouldnt be so attractive. Also keep in mind that if you work for a hospital any moonlighting (has to be approved by them), depositions, and any other 'work' you do the hospital gets a cut !!!

So while it looks great at first sight, just be aware.[/QUOTE]

I agree that other assessments are accurate


I am in PP now but start out with a hospital income guarantee. I came to the conclusion that the goals of the hospital and the goals of the physician are almost always divergent. Expect to see inpatients and all payors. Yes, you dont have to schmooze as much but believe that if your volume falls below an imaginary line drawn in the sand you may be looking for other work. Hospitals can add extra work on at anytime especially if you are getting a stipend. They do this to anesthesia groups all the time. "You will now cover OB", "You will now cover all of our centers without a bigger group". Obviously there are great situations but in general beware and proceed cautiously with hospitals.

Originally Posted by AirBubble

First of all, thank you for your insightful responses.

The "eat what you kill" philosophy offered by some groups sounds stressful and potentially overwhelming to a new provider with no patient base. I think base salary plus productivity incentives would be fair and reasonable. I'm seeing both and wonder if the former should be considered a "red flag"?

yes

Please give me some opinions on this gig?

I fell into a possible hospital-private practice hybrid. I basically interviewed for a gas job and was offered a pain job. The hospital already has the infrastructure and system in place to start a pain clinic. They have a procedure suite with a brand new C-arm and US machine available all but two half days per week. They already have two nurses who staff this suite, one to provide sedation and one to help as the srub; plus an Xray tech. Office space is available on site. They have several physicians who have been dealing with chronic pain patients but that isn't their expertise and they want someone fellowship trained. I am in early talks but was told that they would provide base for two years plus insurance/benefits and practice costs; after which I would be partial owner and it would be "eat what you kill". My feelings are this: they obviously want me to make them money and they apparently think the community has patients to do so, but if I don't make them a ton of money then I may get the boot. That being said, by the time my 2-3 year contract is up then I will be established in the community and can take whatever patients I have recruited with me and start my own gig. Comments, concerns, ect. ???

Originally Posted by W222

Please give me some opinions on this gig?

I fell into a possible hospital-private practice hybrid. I basically interviewed for a gas job and was offered a pain job. The hospital already has the infrastructure and system in place to start a pain clinic. They have a procedure suite with a brand new C-arm and US machine available all but two half days per week. They already have two nurses who staff this suite, one to provide sedation and one to help as the srub; plus an Xray tech. Office space is available on site. They have several physicians who have been dealing with chronic pain patients but that isn't their expertise and they want someone fellowship trained. I am in early talks but was told that they would provide base for two years plus insurance/benefits and practice costs; after which I would be partial owner and it would be "eat what you kill". My feelings are this: they obviously want me to make them money and they apparently think the community has patients to do so, but if I don't make them a ton of money then I may get the boot. That being said, by the time my 2-3 year contract is up then I will be established in the community and can take whatever patients I have recruited with me and start my own gig. Comments, concerns, ect. ???

make sure there is a non-compete

Originally Posted by bedrock

make sure there isn't a non-compete

Fixed it. Don't sign a non-compete.

Originally Posted by PinchandBurn

The perspectives that people have voiced are pretty accurate.

The one issue about being hospital based (that's wht I am) is that you are still an 'employee'. Dont get me wrong, the payis a lot more upfront and great benefits but then you have restrictions set down by admin. You are not paying the RNs so there's always that to contend with. If you have great RNs then you are good, if not, your life will be miserable and feel like residency/fellowship.

I wish the PP offerred great salaries, sign on bonuses, then fellows/new grads would have flocked over to PP and hospitals wouldnt be so attractive. Unfortunately, some PP docs were 'greedy'. So now new grads are flocking to hospitals and pretty soon PP could go bust. I wish the PP docs would really be more welcoming and reward their younger colleagues better upfront. Then PP would be more attractive for the young grad/new grad.

Also keep in mind that if you work for a hospital any moonlighting (has to be approved by them), depositions, and any other 'work' you do the hospital gets a cut !!!

So while it looks great at first sight, just be aware.

Thats pretty true about PP - my experience with PP docs is that they are always looking over their shoulder to see which new young blood is going to try to move in on their turf. It is pretty cutthroat out there, unless a new grad is lucky enough to find a group that is hiring.

The problem about groups, tho, is that some of the concerns that are voiced about hospitals also apply to groups. The group is who decides when a doc gets to "join", that guy invariably has to pay almost a mortgage to join, and before that time can be fired on a whim.

I know a dermatologist who was in that very situation - joined on, salaried, supposed to be allowed to "buy-in" after year 2. By year 5, it was clear that the owner had no interest in ever allowing him to buy in. He left, but the non-compete clause was for 10 miles...

W222, i agree, the concern about up and leaving is that you cant take those patients with you, since almost every group nowadays has a non-compete clause and other clauses that prevent you from taking their patients. and it will take at least a year before your practice starts making good money, most likely, possibly 2 or 3.

I think some personalities are better suited for Hospital based practices. I am certainly not and I want to be my own boss as long as I can. I am joining a small private practice group with a "eat what I kill" model. There is no doubt that it will be stressful to get going but I am looking forward to that challenge. It might take me 6 months to 1 year to get busy so I plan on supplementing my income with moonlighting until than. Not everyone is cut out to hustle and some just need the steady paycheck.

Inside of 5 years, I believe we will see so many major changes in the current interventional pain model that for most physicians, it will not be financially viable. Enjoy it while you can!

Originally Posted by algosdoc

Inside of 5 years, I believe we will see so many major changes in the current interventional pain model that for most physicians, it will not be financially viable. Enjoy it while you can!

I certainly agree with you and it sucks for those of us just coming out of fellowship. I think the key will be to diversify. I know quite a few Anesthesia pain physicians who are moonlighting in ORs and PM&R physicians running small inpatient units or subacute rehab just to make ends meet. This will be the reality for most of us very soon.

Originally Posted by PMR2008

I think some personalities are better suited for Hospital based practices.

1+. I did it for several years, even taught a few fellows. All of my best - brightest, smartest, technically most gifted - left after a year or two for private practice. Ultimately I did too.

There are opportunities to rise up the ladder in hospitals and HMO's but it means donning a suit and tie and going to meetings, managing a department, dealing with toxic staff members, dealing with colleagues who don't have your work ethic and resent you for it, HR, etc.

The personalities that are attracted to a procedural based practice usually aren't the types that 'go corporate'. But times are definately chaning, and we will need to as well.

Originally Posted by Ducttape

W222, i agree, the concern about up and leaving is that you cant take those patients with you, since almost every group nowadays has a non-compete clause and other clauses that prevent you from taking their patients. and it will take at least a year before your practice starts making good money, most likely, possibly 2 or 3.

You probably won't be able to solicit established patients by calling them or sending letters, but nothing stopping you from providing your phone number at the last follow-up visit.

Originally Posted by PMR2008

I think the key will be to diversify. I know quite a few Anesthesia pain physicians who are moonlighting in ORs and PM&R physicians running small inpatient units or subacute rehab just to make ends meet. This will be the reality for most of us very soon.

Plenty of ways to diversify (med-legal, etc.). Doesn't have to be the OR for anesthesiologists or inpatient rehab for Physiatrists.

Originally Posted by PMR2008

I certainly agree with you and it sucks for those of us just coming out of fellowship. I think the key will be to diversify. I know quite a few Anesthesia pain physicians who are moonlighting in ORs and PM&R physicians running small inpatient units or subacute rehab just to make ends meet. This will be the reality for most of us very soon.

* It shouldn't be too bad for people coming out residency/fellowships. You are making 50-55k/year now? You will at least triple or quadruple your salary. Since you never made 400-500k, you won't miss it

* Even with the anticipated cuts, a PM&R pain physician will earn more than an inpatient PM&R physician. You can probably work 4 days/week instead of 7 like inpatient rehab requires and earn more.

Seems like my entire medical career, I've been told that I just barely missed the "golden age" of medicine. Certainly partially true for pain medicine, considered what pain docs were making while I was an MS1.
I'm doing very well right now but, I see the writing on the wall, and I'm saving/investing most of what I"m making and not going too crazy with purchases.

* Even with the anticipated cuts, a PM&R pain physician will earn more than an inpatient PM&R physician. You can probably work 4 days/week instead of 7 like inpatient rehab requires and earn more.

Inpatient PMR has been cut hard as well. Even with the pending pain cuts, outpatient pain/interventions/EMGs will pay more and require less time than running an inpatient rehab unit.
Unless inpatient rehab gets to be twice the pay of pain/EMGs, I'll never go back to it. Half of residency was bad enough.

I'm going back to school to become a dentist. Those dudes print money.

Originally Posted by APDoc

I'm going back to school to become a dentist. Those dudes print money.

I hear you, that is why all of my younger cousins I urge to go I to dentristy and not medicine.

Originally Posted by Jcm800

I hear you, that is why all of my younger cousins I urge to go I to dentristy and not medicine.

im telling the young people i know to go out and become CRNAs or noctors.

less training, less cost of schooling, less stress, and a self-inflated ego, whats not to like?

Originally Posted by Jcm800

I hear you, that is why all of my younger cousins I urge to go I to dentristy and not medicine.

I've mentioned similar things to younger health-care oriented people.

From a pure financial standpoint, dentists and dental subspecialities make great money. Many of the endodontic/oral surgeons pull in 400-500K/year, with less hours and much less stress than MDs. Obviously the general dentists don't make as much, but most pull in 200K plus with 7-8yrs of post-high school training compared to our 13 years (which were much harder years)

However, you gotta do what you enjoy doing and also you must respect yourself doing what you do.
I can't stand just being a pretend doctor and smelling bad breath all day long and not really understanding the entire body. For me, becoming a physician was the only road in healthcare.

However, if somebody's interested in healthcare and their main two priorities are making big bucks as quickly as possible, and having the greatest economic security with the least government hassle/interference......... I point them toward dentistry

one last thing about dentistry, because i dont know if all of us are seeing that the grass is greener...

dentistry, from what i remember, has the highest rate of addiction of any medical specialty, also the highest suicide rate.

Originally Posted by APDoc

I'm going back to school to become a dentist. Those dudes print money.

Originally Posted by Jcm800

I hear you, that is why all of my younger cousins I urge to go I to dentristy and not medicine.

Originally Posted by Ducttape

im telling the young people i know to go out and become CRNAs or noctors.

less training, less cost of schooling, less stress, and a self-inflated ego, whats not to like?

Originally Posted by bedrock

I've mentioned similar things to younger health-care oriented people.

From a pure financial standpoint, dentists and dental subspecialities make great money. Many of the endodontic/oral surgeons pull in 400-500K/year, with less hours and much less stress than MDs. Obviously the general dentists don't make as much, but most pull in 200K plus with 7-8yrs of post-high school training compared to our 13 years (which were much harder years)

I guess pretty soon it will be harder to get into dental school than medical school.....and medical schools will have trouble filling their classes

When I get my EOB from my insurance after seeing a dentist, their reimbursements don't seem great either. He is always pushing cosmetic procedures on me....which dental insurance or a flexible spending account don't reimburse

Originally Posted by Louisville04

I guess pretty soon it will be harder to get into dental school than medical school.....and medical schools will have trouble filling their classes
(

Classically, it's always been much harder to get into medical school than dental school as prestige and money was so much higher for physicians.

If Obama has his way and we all get paid less and become cogs in socialized medicine, I could definitely see the difficulty of medical/dental admission becoming equal.

(After typing that I did a quick search of the dental forum and it seems that is already taking place, the average science GPA of dental applicants is nearly identical to medical applicants, both are now approx 3.5 whereas a decade when I applied, it was much lower (3.0 pre-dent vs 3.6 pre-med science GPA)

When I get my EOB from my insurance after seeing a dentist, their reimbursements don't seem great either. He is always pushing cosmetic procedures on me....which dental insurance or a flexible spending account don't reimburse :

General dentist don't make crazy money, but usually more than FPs, 150-220K. 200K is nothing to sniff at particularly if you start making that at age 25. Remember, some dental schools don't even require a bachelors degree so you can be done 7 years after high school.

The dentists that make the big bucks do require 2-3 years of extra training in an orthodontic or an endodontic residency. This have to be the top of their dental school class to get in, but at age 27-28, they can be making 300-500K depending on if they work as hard as most dentists (30hrs/week) or as hard as most physicians (50+hrs/week)

And the biggest advantage is that those dentist/dental specialist are much less likely to see their a major decline in their income level over their lifetimes, which unfortunately is inevitable for physicians, whether obamacare happens or not.

Originally Posted by Ducttape

one last thing about dentistry, because i dont know if all of us are seeing that the grass is greener...

dentistry, from what i remember, has the highest rate of addiction of any medical specialty, also the highest suicide rate.

Agree with above. There are lots of frustrated dentists out there. Deep down they know they are just highly paid technicians even if they like to call themselves a "doctor"

I couldn't stand being a dentist, despite the advantages in shorter training/income protection.

Originally Posted by bedrock

I couldn't stand being a dentist, despite the advantages in shorter training/income protection.

Agree with you. I thought about it as well while I was premed. 3 of my friends went on to become dentists. One is a periodontist and another is an orthodontist. They are both very happy with their income and probably make 250+ in the east coast. Just like anything else you have to find what you love to do. I love what I do now and I would have hated being a dentist despite the hours and money.
In my current role as an unofficial advisor for a few high school, college and medical school students I tell them that the future for medicine is not bright and the key to success with be in playing the "game" better than the competition. I have convinced some premeds to take up business classes during undergrad and one of my cousins will be doing a MD MBA.

Originally Posted by Louisville04

* It shouldn't be too bad for people coming out residency/fellowships. You are making 50-55k/year now? You will at least triple or quadruple your salary. Since you never made 400-500k, you won't miss it

* Even with the anticipated cuts, a PM&R pain physician will earn more than an inpatient PM&R physician. You can probably work 4 days/week instead of 7 like inpatient rehab requires and earn more.

You are absolutely right. It is a lot worse to get a 50% pay cut vs a 400% raise

Originally Posted by mille125

Hospitals can add extra work on at anytime especially if you are getting a stipend. They do this to anesthesia groups all the time. "You will now cover OB", "You will now cover all of our centers without a bigger group". Obviously there are great situations but in general beware and proceed cautiously with hospitals.

Is it uncommon for issues like additional work responsibilities to be addressed in your contract? Did you have an attorney review it? I'm asking because I've gone back and forth with this. I'm leaning towards attorney review so that I can better understand what I'm signing. I'm sure that employers get frustrated when people make changes to their attorney approved contract. Maybe I'm incorrect?

Originally Posted by AirBubble

Is it uncommon for issues like additional work responsibilities to be addressed in your contract? Did you have an attorney review it? I'm asking because I've gone back and forth with this. I'm leaning towards attorney review so that I can better understand what I'm signing. I'm sure that employers get frustrated when people make changes to their attorney approved contract. Maybe I'm incorrect?

It is standard to have an attorney review a contract. Employers expect this, there should be no rush. In fact, I think if you just grabbed the contract and signed it right away without going over it with a fine tooth comb, that's wierd. Attorney's will cost you a few hundred buck to a grand or two, billing hourly. You want the attorney to pick up big red flag stuff, land mine type clauses you might not pick up through the legalese. You don't want to quibble over every stupid little detail either, because you're just paying the lawyer $250 per hour to do nothing and to irritate your future employer/partners. Make sure they tell you the potential charges up front, estimated time billed, etc, otherwise they'll gouge you.

Anything that is important to you is worth being addressed.

Do a search, there's a pretty big thread on this from last year.

Originally Posted by AirBubble

Is it uncommon for issues like additional work responsibilities to be addressed in your contract? Did you have an attorney review it? I'm asking because I've gone back and forth with this. I'm leaning towards attorney review so that I can better understand what I'm signing. I'm sure that employers get frustrated when people make changes to their attorney approved contract. Maybe I'm incorrect?

For private practice the phrase says, " Medical group may assign employee any tasks that it says is necessary". Hospital contract says something similar. It is usual a rather straight forward statement. The hospitals and/or medical groups are supporting you and want the right to assign you anywhere necessary. They are very unlikely to change it. It is never a bad idea to have an attorney review your contract. However, it does not mean that the group or the hospital is going to do everything (or anything) that the attorney says. Even though I dont feel that any of the senior folks on this forum can substitute for legal counsel, most of us can pick out pitfalls in most contracts.

remember, some things do vary greatly state to state.

definitely have an attorney - preferably a contract attorney - look over your contract. choose which battles to fight over. your attorney will help with this. compromise is the key to make everyone kind of happy...

(which is what congress has forgotten to do...)

Originally Posted by Ducttape

In favor of PP:
1. Much greater financial rewards.
2. Ability to choose what patients you want to see (i.e. good insurance, patients previously not on opioids, etc.)
3. Noone to tell you what you have to do.
4. Can decide what procedures you want to do
5. You get to choose your hours, how you want to work.

It all depends on your group because I've found every point you listed to be completely untrue in a small PP group. And this is because it is no longer a financially viable business model in my region. take cuts, crank up the volume, increase our liability, limit our choices, focus on arbitrary satisfaction rates... we're letting ourselves become extinct

Agreed. My brother is starting medical school this month and I strongly encouraged him to reconsider. $300k in loans is impossible to pay back if you make no money!