Job descriptions

[PPCM]

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Hello,

I'm a 2nd year cardiology fellow at an academic center. I feel like we don't see enough of the non-academic world during training. Can somebody shed light on the nature of what private practice for general cardiology is like now, and compare it to working in a hospital system like Kaiser.

I understand that the private world is diverse and responsibilities vary depending on the group and its hospital affiliations. I just have no idea right now what type of system I'd like to work in. Would rather not deal with the dog-eat-dog world of private practice. On the other hand, I don't know much about the Kaiser system...some say they work you to the bone without much pay, and others say you can work 40-50 hours per week with decent pay.

I actually have a nice medical consulting gig lined up for myself, which pays really well, but it doesn't have the same thrill as practicing cardiology. Would a part time cardiology job be something offered in a big city like Los Angeles-so I can practice half and half?

A lot of questions, I know...just trying to figure out my future. Thanks in advance.

 

[Myostatin]

Lots of variables here.

Your last question is easiest - can you find a part time general cardiology private practice job? Absolutely. The pay will probably not be what you want, but if your goal is just to keep your skills you can definitely find it. But will it fly / be financially worthwhile from the standpoint of your consulting gig? I hope you're not taking about management consulting because good luck trying to juggle the consulting work hours with part time cardiology.

The world of true private practice cardiology and medicine in general is slowly dying. It seems the powers that be will not be satisfied until we're all forced into hospital employment. The reason for this is that the same procedure, say an echo, done in your private practice pays about 50% or less of what the hospital would get paid if the procedure were done in the hospital (at least for now).

Hospital Employment:

Pros: Minimal hastle of regulatory, administrative work; automatic referral base / patient base; minimal risk; relatively predictable salary;
Cons: At the end of the day you are an employee, just like the secretarial staff and every one else. The hospital owns you and you are easily replacable; You will learn little about the health care system, where it is going, and how these changes might affect you; You will have no patient base of your own that is loyal to you, and if you leave the hospital all the time you've put in building a reputation will probably be a waste because you will likely have to sign a non-compete / restrictive covenant when you join.

Private Practice is just the reverse - you have to deal with the huge regulatory / administrative hastle, its much higher risk and you eat what you kill. But at the end of the day you are basically the boss (assuming a fair practice that will allow you to become partner in a timely fashion.... this is key), you will have your own patient base and therefore have intrinsic value independent of anyone else or any other institution - you can use this to leverage yourself if anything goes wrong and you want to leave the practice arrangement. And yes, it is dog eat dog like any other business endeavor.

For what its worth, Kaiser may be the best of a hopsital employed model in that they're #1 - not for profit, #2 anecdotally seem to involve physicians in their administrative processes, etc. But also jobs with Kaiser are not easy to get.

My personal take would be that if you have a great consulting gig lined up that will provide reasonable reward for all your career efforts thus far and seems to have a future, take it and run!! You can always do locum tenens work here and there (maybe a weekend or two a month) to maintain your clinical skills in case anything goes wrong with the consulting gig and you need to come back to medicine full time.