hospital employee vs group

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pogo

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Just wanted to know if there is anyone out there familiar with each of these types of oppurtunities, and could possibly mention the pros and cons of each. It would seem to me that as a hospital employee the only con would be not being your own boss. It would eliminate the office, malpractice and billing hassels. Any thoughts?

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Having gone through this decision recently (ie, hospital employee vs private practice), I can offer some insight.

Being an employee is tempting...you wake up, you go to work, you collect your check. Someone else pays your malpractice and health insurance and does the billing. Sounds great.

But you're right...you are an employee. Someone else tells you how much work you have to do, how much they will pay you, what choice of insurance plans you get, etc. There is little to no independence. Add to that the potential politics, having to be involved in committees, teaching, etc. and it can be a drawback for some.

Private practice obviously affords you the opportunity to be the boss. I can make as much money as I want - if I work more hours, do different procedures, etc. I can choose the people I refer my patients to rather than accepting those who are also hospital employees. I can operate anywhere I have privileges. I can open an ASC. But there is a lot of unpredictability associated with it. I am responsible as the small business owner, I have to make enough to not only feed myself but my employees and the mortgage company come first...they HAVE to be paid. And while there are still hassles with malpractice, billing, etc. I don't do the actual paperwork, I just make sure its done right...so a little more work than as an employee.

In the end I chose a group practice because it was the best situation for me, although I will admit to being fairly tentative about it.

I'm sure Pilot Doc has some useful info to add to mine above.
 
Agree with above.

With the disclaimer that I'm just a surgery resident (soon to be anesthesiology at that) with an interest in the business side of things, I'll add that you need to consider why a hospital wants to hire you. This can be expanded to job hunts in general - attractive jobs don't have to advertise and the longer they advertise the worse a job it is. But I digress ...

Hospitals hire physicians because no one wants to set up a private practice to provide said service. Sometimes this is because of a shortage of docs and the employee offer helps attract new business-nervous grads. More likely it's because the services the hospital needs aren't profitable for a phyisican. As an example, the new surgicalist jobs that are popping up provide coverage for ER patients and emergencies. These activities that are a major burden on the hospital's private surgical staff. Those docs and their profitable elective patients are threatening to (or actually) leaving for greener pastures, so the hospital hires somebody to come deal with all the unscheduled and/or uninsured patients. The hospital is losing money on you and is willing to tolerate that to keep profitable people happy. You end up being the go-to guy for jobs that other surgeons don't want. Keeping other surgeons happy is not always a fun job. That's why many of us look forward to finishing residency. (In fairness, this is somewhat speculation on my part, but I've seen it happen with IM hospitalists.)
 
i would agree with both of what was said above. there are a lot of people going towards the employee vs completely private because of the security. things to consider are your location, the payor mix, and the medical climate in that particular area.

location can be an issue if you are in a specialty that is very well represented in a location and/or you are not in with the major groups. as a new person, this will be tough going. if you are moving to a area that has a high medicaid population, employee or academic. let the hospital eat that cost burden. if an area has only 2 large medical insurers that drive care, be careful because if you do not par with them this can be trouble. high malpractice location in a high malpractice field, you may want someone who is self issued covering you (malpractice in some areas can be $50-200,000 per year for those high risk speicalties)

and for those going into a private practice model (single specialty or multispecialty) as pilot doc said, you are a small business. you really have to be business minded. "you eat what you kill." if you don't collect enough to cover you overhead, you don't get paid. take vacation or get sick, no bills go out, collections drop, no income. as a partner, there are some significant benefits, but most have a "buy in" to the partnership (a friend of my is buying in to his urology practice now, i think the buy in is $300,000)

so as stated previous, employ less risk, less gain; private more risk, more gain.
 
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