primary physician: Private practice vs. Hospital/Employee

[Spirit of the Student Doc]

Hi,

I'm currently listening to a physician give a speech about how much they love their private practice but, many younger doctors seem to prefer working for a hospital etc. and some even seem to have a genuine dislike for private practice.

This seems to have a ton of viewpoints on it and many doctors seem to be hardcore on telling this to many pre-meds....

I'm currently lost on this. So far working for the hospital seems to be the easier but less profitable option (but how much?) Also, why is it so important that pre meds understand this? Furthermore, there happens to be these primary care physicians that leave their practices and end up working in other sectors.... how is this even possible (I mean like emergency physician and even hospitalist on Internal Medicine).

Also, do adcoms really care if I understand this? If so why?

Thanks in advance
-Spirit of the Student Doc

P.S.
I almost signed my real name

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[Spirit of the Student Doc]

I found a decent article on this
http://www.washingtonpost.com/natio...y-care-doctors/2011/05/31/AGYutAcH_story.html

not sure what to make of it

 

[Spirit of the Student Doc]

Guys, I can ask this primary care physician questions.

Let me know if you have any

 

[Miss_Premed]

I think the biggest turn off for me is the obsession with quantity of patients. Fifteen minutes is not a lot of time at all! Good care should allow for flexibility. Perhaps patient 1 needs only 15 minutes but patient 2 is very complex and need 25. It would be unethical to ignore or rush care simply to see a new patient every 15 minutes on the dot. Im pretty sure my primary care doctor is only allotted about 15 per visit as well. I usually leave feeling rushed with an order to book a follow up or an issue that couldn't be resolved in 15. I don't think that healthcare should be an assembly line, moving at 15 minute intervals.

 

[NickNaylor]

Pros of working for a hospital:
-typically have overhead covered (e.g., malpractice, billing, etc.)
-don't have to worry about finding your own patients
-easier to take vacation as responsibilities can be diffused over the rest of the staff

Cons of working for a hospital:
-you are a highly trained employee
-administrators play a role in dictating your practice habits
-you generally, but not always, will make less than what you would make with a successful practice

Reverse those things for a private practice. Private practices also allow you to decide how YOU want to practice medicine. The above post is a great example. At a hospital, administrators will be breathing down your neck to make sure that you're as "productive" as possible. Often, this means double-booking appointments and using standardized visit times irrespective of the complexity of the problems of the patients you're seeing.

That said, working for a hospital practice is desirable in some ways because the blood, sweat, and tears of building a practice isn't a concern. There are often at least a few years of long, hard hours for reduced pay to build a practice. Working for a hospital has no such "warm-up" period. There's also the inherent risk of striking out on your own. For many, that's too much risk.

Personally I'm drawn to starting my own practice largely because 1) I want to practice how I want to practice and 2) I have an intrinsic interest in entrepreneurship that I think will be satisfied by starting and owning a practice. I hate the idea of working for The Man, and I'm strongly motivated to avoid doing so.

I don't think anyone will care for the purposes of medical admissions. You might get some sneers by those in academia by being candid about your interest in private practice. Often "private practice" is interpreted as "greed" by those in academia. Not everyone believes that, but it's happened frequently enough to make a trend.

 

[Spirit of the Student Doc]

I think the biggest turn off for me is the obsession with quantity of patients. Fifteen minutes is not a lot of time at all! Good care should allow for flexibility. Perhaps patient 1 needs only 15 minutes but patient 2 is very complex and need 25. It would be unethical to ignore or rush care simply to see a new patient every 15 minutes on the dot. Im pretty sure my primary care doctor is only allotted about 15 per visit as well. I usually leave feeling rushed with an order to book a follow up or an issue that couldn't be resolved in 15. I don't think that healthcare should be an assembly line, moving at 15 minute intervals.

Yeah, she said that as well. Also, she said because she's at a smaller city she might even make house calls.

 

[Spirit of the Student Doc]

Pros of working for a hospital:
-typically have overhead covered (e.g., malpractice, billing, etc.)
-don't have to worry about finding your own patients
-easier to take vacation as responsibilities can be diffused over the rest of the staff

Cons of working for a hospital:
-you are a highly trained employee
-administrators play a role in dictating your practice habits
-you generally, but not always, will make less than what you would make with a successful practice

Reverse those things for a private practice. Private practices also allow you to decide how YOU want to practice medicine. The above post is a great example. At a hospital, administrators will be breathing down your neck to make sure that you're as "productive" as possible. Often, this means double-booking appointments and using standardized visit times irrespective of the complexity of the problems of the patients you're seeing.

That said, working for a hospital practice is desirable in some ways because the blood, sweat, and tears of building a practice isn't a concern. There are often at least a few years of long, hard hours for reduced pay to build a practice. Working for a hospital has no such "warm-up" period. There's also the inherent risk of striking out on your own. For many, that's too much risk.

Personally I'm drawn to starting my own practice largely because 1) I want to practice how I want to practice and 2) I have an intrinsic interest in entrepreneurship that I think will be satisfied by starting and owning a practice. I hate the idea of working for The Man, and I'm strongly motivated to avoid doing so.

I don't think anyone will care for the purposes of medical admissions. You might get some sneers by those in academia by being candid about your interest in private practice. Often "private practice" is interpreted as "greed" by those in academia. Not everyone believes that, but it's happened frequently enough to make a trend.

Huh, these doctors that visit our pre-med club seem to think otherwise.

Anyways, just to put out what this doctors talk was about:

This doctor worked at a hospital for a while, then opened her own private practice. She also said something about how she could've been more profitable if she knew more about coding from the get-go (didn't quite understand why). She's able to customize her time better and has more freedom to take vacation, etc.

Also, she said depending on where you live, you might only need a Degree to work in a E.R. and so forth, but it's not typical everywhere. She herself moonlighted in the E.R. for some extra cash (that's cool I suppose).

Learned a bit I suppose.

 

[NickNaylor]

Huh, these doctors that visit our pre-med club seem to think otherwise. This doctor worked at a hospital for a while, then opened her own private practice. She also said something about how she could've been more profitable if she knew more about coding from the get-go (didn't quite understand why). She's able to customize her time better and has more freedom to take vacation, etc.

Also, depending on where you live, you might only need a Degree to work in a E.R. and so forth, but it's not typical everywhere. She herself moonlighted in the E.R. for some extra cash.

Learned a bit I suppose.

I don't know what portions of what you said disagree with my post. It's not uncommon for providers to work for hospitals for a few years before going into private practice. I know it's particularly common in psychiatry.

 

[Spirit of the Student Doc]

I don't know what portions of what you said disagree with my post. It's not uncommon for providers to work for hospitals for a few years before going into private practice. I know it's particularly common in psychiatry.

Oh, I don't disagree. Just thought I'd share was all. The only reason I could see any value for a pre-med would be in case of a interview question, but I doubt adcoms go that into it.

 

[songl4a]

.

 

[NickNaylor]

You could bypass some of these hurdles by joining a group.

Yes, certainly possible. But depending on the setup of the practice you may be one rung higher than "highly trained employee." But that's certainly another possibility.

 

[Catalystik]

Setting up your own practice would typically require taking out a loan to cover office equipment, overhead, and staff wages (not to mention your own living expenses) until you get busy enough to cover expenses.

Buying an existing practice requires coming up with the perceived value of the practice either through a loan or monthly payments from practice receipts to the previous owner.

Joining a practice and becoming a partner generally involves a buy-in price after a trial period, which can be deducted from take-home salary, gives one a say in how the practice is run, lets you set up your schedule the way you want it, and eventually leads to a full share of the practice profits and job security.

Working for a practice or a hospital gives all the control to one's boss, no guarantee of permanent employment or salary beyond the first contract period, but easier mobility if you aren't satisfied with how things are run, salary and benefits, on-call obligations, or pressure to increase performance. This would be a way to save up money for some of the above options, though, and to get an idea of what it takes to run a business.

 

[LizzyM]

Huh, these doctors that visit our pre-med club seem to think otherwise.

Anyways, just to put out what this doctors talk was about:

This doctor worked at a hospital for a while, then opened her own private practice. She also said something about how she could've been more profitable if she knew more about coding from the get-go (didn't quite understand why). She's able to customize her time better and has more freedom to take vacation, etc.

Every visit and every procedure has a code. The code assigned influences how one is paid. Making an error and coding the visit or procedure incorrectly ("up coding") can result in large fines as it can be considered fraud but not checking all the boxes and coding for everything that was done, or coding for a lower complexity visit when a higher complexity visit was justifiable, can result in lower reimbursement.

Also, she said depending on where you live, you might only need a Degree to work in a E.R. and so forth, but it's not typical everywhere. She herself moonlighted in the E.R. for some extra cash (that's cool I suppose).

Learned a bit I suppose.

You need a medical license to work in the ER as a physician and that requires at least a year of residency, not just a degree.

 

[LChristmas]

Also, she said depending on where you live, you might only need a Degree to work in a E.R. and so forth, but it's not typical everywhere. She herself moonlighted in the E.R. for some extra cash (that's cool I suppose).

Perhaps she was talking about a free-standing Urgent Care facility.

 

[Catalystik]

Perhaps she was talking about a free-standing Urgent Care facility.

Maybe the intent was to convey that one needed to be Board Certified or Board Eligible in Emergency Medicine (which requires completion of a three year residency) to work in some EDs, which seems common in bigger hospitals, but not necessary in more rural areas.

 

[Spirit of the Student Doc]

I found a article on this:
A shortage of emergency medicine specialists means many hospitals will need to use physicians trained in primary care. For critical access facilities, such physicians may be a better fit.
http://www.hhnmag.com/display/HHN-n...ata/HHN/Daily/2012/May/greig051012-1290003632

and on credentials
Central to the issue of family physicians practicing emergency medicine are fundamental concerns over competency, job security, and certification. Many family physicians have made careers in emergency medicine, and in rural areas family physicians will always be the primary providers of emergency care. At the same time, the criteria for staffing emergency departments have emphasized board certification over actual physician performance.
http://www.aafp.org/about/policies/all/critical-challenges.html

 

[Spirit of the Student Doc]

Maybe the intent was to convey that one needed to be Board Certified or Board Eligible in Emergency Medicine (which requires completion of a three year residency) to work in some EDs, which seems common in bigger hospitals, but not necessary in more rural areas.

Maybe, I know having worked in a rural hospital and having seen many others that the E.R. doctors there may be family physicians (over 50% in some cases), what they went through to get there I've never asked.

 

[Spirit of the Student Doc]

Every visit and every procedure has a code. The code assigned influences how one is paid. Making an error and coding the visit or procedure incorrectly ("up coding") can result in large fines as it can be considered fraud but not checking all the boxes and coding for everything that was done, or coding for a lower complexity visit when a higher complexity visit was justifiable, can result in lower reimbursement.



You need a medical license to work in the ER as a physician and that requires at least a year of residency, not just a degree.

Thanks for the update on coding, learn something everyday. As for the ER, not that I have a personal interest in this, is it possible they went through some kind of training. A lot of rural hospitals seem to be a position they have to bridge the gap by hiring more family physicians.

 

[LizzyM]

Thanks for the update on coding, learn something everyday. As for the ER, not that I have a personal interest in this, is it possible they went through some kind of training. A lot of rural hospitals seem to be a position they have to bridge the gap by hiring more family physicians.

A physician needs a license, not just a medical degree, to practice independently (not under the supervision of a licensed physician). To be licensed, one needs a medical degree and at least one year of residency training, plus a passing grade on a licensing exam.

Some places will take a licensed physician who is not Board Eligible or Board Certified (meaning that they have had additional training beyond one year of residency and passed, or are eligible to sit for, a board exam) and places that have a hard time attracting physicians (very rural places, areas that serve mostly the poor, places where most people would not choose to live if they had choices) may not be picky as long as someone is licensed.

 

[Spirit of the Student Doc]

A physician needs a license, not just a medical degree, to practice independently (not under the supervision of a licensed physician). To be licensed, one needs a medical degree and at least one year of residency training, plus a passing grade on a licensing exam.

Some places will take a licensed physician who is not Board Eligible or Board Certified (meaning that they have had additional training beyond one year of residency and passed, or are eligible to sit for, a board exam) and places that have a hard time attracting physicians (very rural places, areas that serve mostly the poor, places where most people would not choose to live if they had choices) may not be picky as long as someone is licensed.

Oh ha ha, it seems like we've been talking over each other then. Yes, I believe she and all the others have done residency somewhere, just not in the E.R. Also, I think she had to take some extra tests every so often to maintain her ability to work in the E.R. or something, but she said it was the equivalent of reading medical blogs.