NYT: "More Doctors Giving Up Private Practices"

[johncalvin]

....and instead going on salaried jobs.

In 2005, 66% of doctors were in private-practice. Now, under 50% are...wow

http://www.nytimes.com/2010/03/26/health/policy/26docs.html

Where do you folks want to work once you're at the end of the tunnel? Private practice or as a hospital employee?

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[MilkmanAl]

With the recent Medicare cuts, I don't see a whole lot of motivation to not be salaried if you're in one of the lower-earning medical fields.

 

[randombetch]

"But the young people coming out of training now don't want to do much call and don't want the risk of buying into a practice, but they still want a good lifestyle and a big salary. You can't have it both ways."

Very interesting..

 

[boaz]

Salaried job.

 

[skiddoc]

I'm thinking that quality of healthcare might actually decline, due to people refusing to see unfamiliar doctors in big hospital conglomerates. America is, after all, still very conservative.

 

[kstreet]

Salaried job.

Why would you want a salaried job?

That means you have to report to a boss. Why not be your own boss?

 

[MegaProjectile]

While salaried jobs sound like a good idea coupled with less risk, its important to realize how much a doctor is worth to a hospital. I think the WSJ did a report that showed how much one doctor brings to a hospital. The hospital assumes the risk and administrative headache but in return they pay you anywhere from 1/4th to 1/10th of what you bring in. This is worse than the 50% a temp agency pays you for helping with job placement.

Not everyone is cut out for private practice especially med students with very little business acumen but the pay off can be good for those do and are willing to work hard.

 

[dru2002]

While salaried jobs sound like a good idea coupled with less risk, its important to realize how much a doctor is worth to a hospital. I think the WSJ did a report that showed how much one doctor brings to a hospital. The hospital assumes the risk and administrative headache but in return they pay you anywhere from 1/4th to 1/10th of what you bring in. This is worse than the 50% a temp agency pays you for helping with job placement.

Not everyone is cut out for private practice especially med students with very little business acumen but the pay off can be good for those do and are willing to work hard.

Of course the hospital pays you so little. They are assuming the risk and adminstrative headache. I know this is going to sound silly, but to me I would rather not deal with that BS and take a huge paycut then have to deal with all the responsibilities that come with private practice. Others are more than willing to deal with the adminstrative duties to make a 100K+ more a year.

 

[smarty666]

I can see what this article is talking about! I live in central NJ and I know that my local healthcare system just changed their policies in the last 2 years, at least worse off for the patients!

Both my mother and I were hospitalized at some point at our local hospital last year and both times we were under the care of some hospitalist who didn't know our history or anything about us from atom and when we wanted your primary care internist to oversee our care while in the hospital we were told no and that primary care doctors in the county no longer had hospital call for their patients; the only reason my room mate had her family practiconer finally come in and oversee her care was she threatened her hospitalist she would leave the hospital if she could not see her GP!

I still can't believe they changed their policy to this and I personally think it is a major violation of patient rights but when I finally saw my internist after being discharged I talked with him about this and he said that this is the beginning trend for primary care and he expects it to be adopted by more and more healthcare systems as the years go on! They are doing this to promote the hospitalist position and more and more primary care doctors are going to salaried hospitalist positions rather than going into private practice as a internist or family practitioner! I guess it makes the lives of private practice primary care doctors easier if they don't have hospital call anymore! to me it just makes more work for the patient because once you leave the hospital you don't see the hospitalist ever again and then you see your GP and he doesn't no anything of why, how, or what happen while you were hospitalized so you have to go through the whole story again!!

My internist said he expects more and more primary care doctors to go into salaried hospitalist positions and that private practice is going to be supplemented more by NPs and PAs with the doctors already in practice! My internist himself used to have a DO in with him but once she left, he now has two NPs and himself in the practice!

I'm just curious since I'm not in a residency or have gone to med school, but how difficult is it to go into private practice after completing your internal medicine or family medicine residency program?? I would expect that most primary care doctors who want to go into private practice try to find a already established practice and go in as a junior associate, work with the establish practice for several years before going off into their own practice? isn't that a easier way to go into private practice rather than trying to start a practice on your own?? just curious to find out!!

 

[TooMuchResearch]

I can see what this article is talking about! I live in central NJ and I know that my local healthcare system just changed their policies in the last 2 years, at least worse off for the patients!

Both my mother and I were hospitalized at some point at our local hospital last year and both times we were under the care of some hospitalist who didn't know our history or anything about us from atom and when we wanted your primary care internist to oversee our care while in the hospital we were told no and that primary care doctors in the county no longer had hospital call for their patients; the only reason my room mate had her family practiconer finally come in and oversee her care was she threatened her hospitalist she would leave the hospital if she could not see her GP!

I still can't believe they changed their policy to this and I personally think it is a major violation of patient rights but when I finally saw my internist after being discharged I talked with him about this and he said that this is the beginning trend for primary care and he expects it to be adopted by more and more healthcare systems as the years go on! They are doing this to promote the hospitalist position and more and more primary care doctors are going to salaried hospitalist positions rather than going into private practice as a internist or family practitioner! I guess it makes the lives of private practice primary care doctors easier if they don't have hospital call anymore! to me it just makes more work for the patient because once you leave the hospital you don't see the hospitalist ever again and then you see your GP and he doesn't no anything of why, how, or what happen while you were hospitalized so you have to go through the whole story again!!

My internist said he expects more and more primary care doctors to go into salaried hospitalist positions and that private practice is going to be supplemented more by NPs and PAs with the doctors already in practice! My internist himself used to have a DO in with him but once she left, he now has two NPs and himself in the practice!

I'm just curious since I'm not in a residency or have gone to med school, but how difficult is it to go into private practice after completing your internal medicine or family medicine residency program?? I would expect that most primary care doctors who want to go into private practice try to find a already established practice and go in as a junior associate, work with the establish practice for several years before going off into their own practice? isn't that a easier way to go into private practice rather than trying to start a practice on your own?? just curious to find out!!

Relax. With. The. Punctuation.

 

[MegaProjectile]

Of course the hospital pays you so little. They are assuming the risk and adminstrative headache. I know this is going to sound silly, but to me I would rather not deal with that BS and take a huge paycut then have to deal with all the responsibilities that come with private practice. Others are more than willing to deal with the adminstrative duties to make a 100K+ more a year.

It depends on the specialty. The cardiologist is getting paid 400k+ to work for the hospital while bringing in 4x the amount his making. 400K+ is a good salary so I can see why some people will take it and run. However, if I were going into PCP(FM, IM) there is no way I can justified being paid 1/10th of what I bring in.

The only way I can do this is by having a one week on and one week off with the hospital. Use my off week for private practice patients to supplement my income.

 

[Freezer]

i think to the average reader, this article is misleading... it suggests that we are going to see this massive move of physicians from small local facilities to big impersonal hospitals... however, a majority of what we think to be private practices are not truly private practice... your typical "private practice" clinic is usually run by larger corporations, such as HCA... unless you hold an MBA on top of your MD, it is rather difficult to keep a private health facility afloat... anyways, private practice docs are not typically moving into large hospitals... they are just turning their management over to another company... they can stay in the same facility, keep the same patients, and even keep the same flexible schedule... the numbers from this article include these types of management exchanges... when the article stated that the numbers of physician owned clinics dropped 50% in 2005, that doesn't necessarily mean they all closed up shop and moved into a large hospital... most of them just figured they would leave the paperwork to someone else...

now i will also be the first to admit that moving your management to someone like HCA is not always a perfect transition... but i will also be the first to point out that Gardiner Harris, author of this article, has been very critical of our current administrations health care reform... and observing that this article was misleadingly written from the "no more local private physician for me" slant rather than the "HMO's and large hospitals have issues" slant... well, lets just say there is too much bias from the get go for me to take this article too seriously...

 

[BlueElmo]

This is a very interesting article. Obama's reform would probably even further continue the shift away from private practice, I imagine.

 

[littlealex]

This happened 10 years ago. Old news.

 

[D0WNxSH1FT]

i think to the average reader, this article is misleading... it suggests that we are going to see this massive move of physicians from small local facilities to big impersonal hospitals... however, a majority of what we think to be private practices are not truly private practice... your typical "private practice" clinic is usually run by larger corporations, such as HCA... unless you hold an MBA on top of your MD, it is rather difficult to keep a private health facility afloat... anyways, private practice docs are not typically moving into large hospitals... they are just turning their management over to another company... they can stay in the same facility, keep the same patients, and even keep the same flexible schedule... the numbers from this article include these types of management exchanges... when the article stated that the numbers of physician owned clinics dropped 50% in 2005, that doesn't necessarily mean they all closed up shop and moved into a large hospital... most of them just figured they would leave the paperwork to someone else...

now i will also be the first to admit that moving your management to someone like HCA is not always a perfect transition... but i will also be the first to point out that Gardiner Harris, author of this article, has been very critical of our current administrations health care reform... and observing that this article was misleadingly written from the "no more local private physician for me" slant rather than the "HMO's and large hospitals have issues" slant... well, lets just say there is too much bias from the get go for me to take this article too seriously...

+1, I don't think they are saying Doctors are moving to hospitals, I think they are just giving up their full ownership to be apart of a larger group.

For example, my Dermatologist and PCP used to be completely seperate private practices. Today they, like most of the Dr Offices here, are in the Mt. Kisco Medical Group. They have offices throughout the southern NY area. They manage the practice and you care for the patients.

 

[smarty666]

Relax. With. The. Punctuation.

instead of worrying like a fool about my punctuation why can't you either answer my question at the end of the post or don't respond at all

 

[smarty666]

+1, I don't think they are saying Doctors are moving to hospitals, I think they are just giving up their full ownership to be apart of a larger group.

For example, my Dermatologist and PCP used to be completely seperate private practices. Today they, like most of the Dr Offices here, are in the Mt. Kisco Medical Group. They have offices throughout the southern NY area. They manage the practice and you care for the patients.

so I guess your saying that doctors in practice either by themselves or with one other doctor are closing their practices and moving into larger private practice groups?? I guess that gives them a little less work if your with a larger private practice since then you can spread call out amongst all the associates in the group rather than having call all the time when you had your own practice!

because if a internist or family practitioner moves to a hospital, don't they then become a hospitalist?

 

[Musclemass]

Relax. With. The. Punctuation.

+1. Overly emphatic punctuation is annoying. Same as all caps or no caps.

The system is broken and needs to change. Most people find change uncomfortable. Sometimes broken things need to be changed a few times before the right solution is found.

The key word = relax.

 

[TooMuchResearch]

instead of worrying like a fool about my punctuation why can't you either answer my question at the end of the post or don't respond at all

I'm sorry!! I didn't mean to offend you!!! Why don't you just chill out???

Stop hating on hospitalists!?! Some of them (!) are cool dudes!!

 

[smarty666]

+1. Overly emphatic punctuation is annoying. Same as all caps or no caps.

The system is broken and needs to change. Most people find change uncomfortable. Sometimes broken things need to be changed a few times before the right solution is found.

The key word = relax.

again if things like over punctuation are annoying you, then I hate to see how you handle the little things in life! get off your high horse and get over it!

your point doesn't do anything to answer a question I've been asking for clarification on or the subject about hospital vs private practice for doctors! we all know the system is broken, yes, but how should it be changed, give specifics man! do you agree with the NYT article or not?

 

[TooMuchResearch]

again if things like over punctuation are annoying you, then I hate to see how you handle the little things in life! get off your high horse and get over it!

your point doesn't do anything to answer a question I've been asking for clarification on or the subject about hospital vs private practice for doctors! we all know the system is broken, yes, but how should it be changed, give specifics man! do you agree with the NYT article or not?

Yes, I agree with the article. Fewer docs have been going into private practice. I'd suggest you read littlealex's post and move on.

 

[smarty666]

I'm sorry!! I didn't mean to offend you!!! Why don't you just chill out???

Stop hating on hospitalists!?! Some of them (!) are cool dudes!!

not any of the ones I have met while in the hospital have been cool dudes! all have been a$%holes who couldn't even introduce themselves or shake my hand for the first time when meeting, didn't even care to hear my medical history, ask what medications I've been taking, and barely gave me 3 minutes of his time, oh and changed my medications without even telling me why and what medication he was changing them to, to my face!

he made his lacky nurse do it, and it was a good thing I asked what medication it was because I was allergic to the medication he switched me too, but of course there wouldn't have been a problem if he had freaking took the time to speak to me about my allergies or why he wanted to change my medicines in the first place!

maybe you've had different experiences with your hospitalist, but so far I've been unimpressed!

 

[smarty666]

Yes, I agree with the article. Fewer docs have been going into private practice. I'd suggest you read littlealex's post and move on.

I don't understand why you have to get so sarcastic and snippy about this; his half sentence response doesn't tell me more then that this trend began over 10 years ago! I'm trying to find out why? I was in middle school at the time so I was sitting there reading journals and articles about the health care system

it is because it is easier to become a hospitalist after residency then to find a established private practice to become a associate in?

 

[Ponger]

not any of the ones I have met while in the hospital have been cool dudes! all have been a$%holes who couldn't even introduce themselves or shake my hand for the first time when meeting, didn't even care to hear my medical history, ask what medications I've been taking, and barely gave me 3 minutes of his time, oh and changed my medications without even telling me why and what medication he was changing them to, to my face!

he made his lacky nurse do it, and it was a good thing I asked what medication it was because I was allergic to the medication he switched me too, but of course there wouldn't have been a problem if he had freaking took the time to speak to me about my allergies or why he wanted to change my medicines in the first place!

maybe you've had different experiences with your hospitalist, but so far I've been unimpressed!

Hahaha. After reading everyone else's commentary on your writing style, I'm inclined to agree with them.

I'm going to channel some Kenny Powers on this one. Smarty666, no offense to the content of your writing but you type like a dickhead.

Yes, it is probably easier to become a hospitalist than to join a practice.

 

[smarty666]

Hahaha. After reading everyone else's commentary on your writing style, I'm inclined to agree with them.

I'm going to channel some Kenny Powers on this one. Smarty666, no offense to the content of your writing but you type like a dickhead.

Yes, it is probably easier to become a hospitalist than to join a practice.

Ah, instead of just answering my question without the personal put down it just goes to show your well on your way to getting the arrogant/jaded medical doctor attitude training in med school that your suppose to, CONGRATUALATIONS .

It is not like I am typing a journal article or thesis here, I'm not putting any emphasis on grammar or how I'm typing when just casually talking about health care topics. You all need to learn to chill and not nit pick everything! There is more to life then punctuation. I can not believe you are all making such a big deal out of nothing over how I type. I think you all have more issue with how I feel about hospitalist than my grammar and punctuation in posting.

 

[TexasFight]

Ah, instead of just answering my question without the personal put down it just goes to show your well on your way to getting the arrogant/jaded medical doctor attitude training in med school that your suppose to, CONGRATUALATIONS .

It is not like I am typing a journal article or thesis here, I'm not putting any emphasis on grammar or how I'm typing when just casually talking about health care topics. You all need to learn to chill and not nit pick everything! There is more to life then punctuation. I can not believe you are all making such a big deal out of nothing over how I type. I think you all have more issue with how I feel about hospitalist than my grammar and punctuation in posting.

Haha, everyone seems to be controlling their temper.

I don't think they will be jaded or arrogant, TooMuchResearch, etc. all seem really chill.


P.S. good job only using one "!" it was particularly impressive to not put in three after "CONGRATULATIONS"

 

[dru2002]

Ah, instead of just answering my question without the personal put down it just goes to show your well on your way to getting the arrogant/jaded medical doctor attitude training in med school that your suppose to, CONGRATUALATIONS .

It is not like I am typing a journal article or thesis here, I'm not putting any emphasis on grammar or how I'm typing when just casually talking about health care topics. You all need to learn to chill and not nit pick everything! There is more to life then punctuation. I can not believe you are all making such a big deal out of nothing over how I type. I think you all have more issue with how I feel about hospitalist than my grammar and punctuation in posting.

A) I agree with above about diction and grammar.

B) I think the major offense comes when you essentially bash a large chunk of internists (hospitalists) with limited experience. Was it just that hospital that had crappy hospitalists or all hospitals? How many hospitalists did you interact with? Did the hospital have a staffing shortage of hospitalists? These are all important questions which need to be answered before you bash all hospitalists. There are also the questions of you and your families interactions with them. Did you come across as arrogant or obnoxious? Did you make the hospitalist disdain entering your room? Obviously a professional shouldn't be influenced by these things, but they are still human and are subject to human emotions. Again, these are all aspects that need to be explored before bashing said profession.

PS I'm confident that I have made a few spelling and or grammatically errors, but on the whole I believe it is easily readable, which should be the point of any communication. Feel free to notify me of any glaring errors. Thanks.

 

[dru2002]

It depends on the specialty. The cardiologist is getting paid 400k+ to work for the hospital while bringing in 4x the amount his making. 400K+ is a good salary so I can see why some people will take it and run. However, if I were going into PCP(FM, IM) there is no way I can justified being paid 1/10th of what I bring in.

Definitely a great point. I can't see giving up that much money when you already aren't being paid very well.

 

[smarty666]

Haha, everyone seems to be controlling their temper.

I don't think they will be jaded or arrogant, TooMuchResearch, etc. all seem really chill.


P.S. good job only using one "!" it was particularly impressive to not put in three after "CONGRATULATIONS"

Instead of focusing on typing, grammar, and punctuation I was really interested in discussing the topic at hand. If more and more general practitioners are going into a hospitalist position rather then be an internist or family practitioner in private practice, wouldn't there eventually be a really big shortage of private practice doctors? A hospitalist cannot see or follow up with you once your discharged from the hospital. I would assume that even specialist, cardiology, dermatology, neurology, etc would have to have some office or private practice outside the hospital in order to see and follow up with patients upon discharge wouldn't they?

 

[smarty666]

A) I agree with above about diction and grammar.

B) I think the major offense comes when you essentially bash a large chunk of internists (hospitalists) with limited experience. Was it just that hospital that had crappy hospitalists or all hospitals? How many hospitalists did you interact with? Did the hospital have a staffing shortage of hospitalists? These are all important questions which need to be answered before you bash all hospitalists. There are also the questions of you and your families interactions with them. Did you come across as arrogant or obnoxious? Did you make the hospitalist disdain entering your room? Obviously a professional shouldn't be influenced by these things, but they are still human and are subject to human emotions. Again, these are all aspects that need to be explored before bashing said profession.

PS I'm confident that I have made a few spelling and or grammatically errors, but on the whole I believe it is easily readable, which should be the point of any communication. Feel free to notify me of any glaring errors. Thanks.

You make all valid points about my experience and the one my mother had. It could be just something indicative of the specific hospital we were at, but I can assure you it had nothing to do with how we treated them personally. In fact, I was in the hospital for 3 days and had 2 different hospitalist treat me. Both had the same lousy bedside manner. Both did not introduce themselves when meeting me for the first time. Both did not inform me that they were changing medications or ask what my allergies were before doing so. Both my hospitalist had no idea what test or medications my specialists had ordered for me, which demonstrated to me a lack of communication. Both hospitalist I had, spent little more than 2 minutes with me each day I was there nor gave me any kind of examination.

My mother was hospitalized for 2 and a half weeks at the same hospital/floor. She had 4 different hospitalist during her stay and was treated the same way I was. Now since we had trouble with multiple doctors at the same hospital, it is more likely a issue relating to that hospital and possibly a shortage or policy problem at that location. Does it mean all hospitalist are bad? Of course not. I was not trying to demonize the whole profession. I've been given similar treatment often on over the years by surgeons, specialists, you name it, so these hospitalist were not alone in that regard. I was also surprised at the lack of communication between each hospitalist, that was supervising her care, with the specialists who were seeing her as well.

I just pray for you and everyone else that the hospitalist in-patient system at your hospital is far better than the one that is at my local hospital.

 

[Ponger]

Ah, instead of just answering my question without the personal put down it just goes to show your well on your way to getting the arrogant/jaded medical doctor attitude training in med school that your suppose to, CONGRATUALATIONS .

It is not like I am typing a journal article or thesis here, I'm not putting any emphasis on grammar or how I'm typing when just casually talking about health care topics. You all need to learn to chill and not nit pick everything! There is more to life then punctuation. I can not believe you are all making such a big deal out of nothing over how I type. I think you all have more issue with how I feel about hospitalist than my grammar and punctuation in posting.

Sorry if it seemed like a personal attack but being able to communicate effectively is an important trait. Take a step back and note that several people commented on your typing ability. It undercuts what I later gathered to be honest concerns about the quality of hospitalist care.

 

[TooMuchResearch]

I don't understand why you have to get so sarcastic and snippy about this; his half sentence response doesn't tell me more then that this trend began over 10 years ago! I'm trying to find out why? I was in middle school at the time so I was sitting there reading journals and articles about the health care system

it is because it is easier to become a hospitalist after residency then to find a established private practice to become a associate in?

Hospitalist's start around $180,000 per year, have manageable hours, don't take call, and get to wear scrubs every day (feeling cool and comfortable is worth about $20,000 per year, if not more).

 

[smarty666]

Hospitalist's start around $180,000 per year, have manageable hours, don't take call, and get to wear scrubs every day (feeling cool and comfortable is worth about $20,000 per year, if not more).

That is a very valid argument for becoming a hospitalist. Though every hospitalist my mother and I had wore dress outfits and a tie everyday, at least when we saw them. I never once saw a hospitalist on the floor wearing scrubs. Like I said earlier, every hospital and their policies are different.

 

[smarty666]

Sorry if it seemed like a personal attack but being able to communicate effectively is an important trait. Take a step back and note that several people commented on your typing ability. It undercuts what I later gathered to be honest concerns about the quality of hospitalist care.

I have started capitalizing, adding periods, making sure commas are in where they need to be, etc. Is every one happy now? I'm if I have offended anyone. Again, I should have made it clear in my original post, I was not trying to denigrate the entire hospitalist profession, just state my own personal experience and how it needs to be improved.

 

[Squeal]

Ah, instead of just answering my question without the personal put down it just goes to show your well on your way to getting the arrogant/jaded medical doctor attitude training in med school that your suppose to, CONGRATUALATIONS .

It is not like I am typing a journal article or thesis here, I'm not putting any emphasis on grammar or how I'm typing when just casually talking about health care topics. You all need to learn to chill and not nit pick everything! There is more to life then punctuation. I can not believe you are all making such a big deal out of nothing over how I type. I think you all have more issue with how I feel about hospitalist than my grammar and punctuation in posting.

Although I understand that SDN is definitely not a place where you should be overly concerned with spelling and grammar errors, it is still a place where people like to discuss intelligent issues in an intelligent manner (most of the time).

Most of us are guilty of typing like you every once in a while on here (and who really cares?), but if you want your questions considered seriously and answered thoughtfully, you might want to avoid the use of excessive punctuation, all caps, and broad generalizations based solely on your anecdotal experience.

I'm sure that there are many people that would like to consider the answers to your questions and their implications (I personally have no experience in the matter), but there are much more tactful ways of gaining that information. SDN is supposed to be a community of professionals and aspiring professionals, right?

 

[smarty666]

Just like every specialty in medicine is a little different from each other, I guess when it comes down to whether being in private practice or on salary in a hospital setting, it depends on what lifestyle you want.

After seeing the hospitalist and what my internist do, if I had to choose, I'd prefer to be in private practice with a group rather than be a hospitalist. Though, I can see why some of the advantages to being a hospitalist make it an attractive alternative to private practice. I personally like private practice better because it gives you a break away from the high-stress hospital setting for a little while and you get to really know your patients and their family/history. One thing I would not like about being a hospitalist is just seeing patients for the 1-2 days or for however long they are admitted and not being able to follow up and know how they are doing post discharge.

I do not know if I mentioned it earlier, but my health care system has done away with hospital call for all private practice internists and family practitioners who have hospital privileges at that hospital. That makes private practice GPs lives a lot easier. They are not allowed to see you if your admitted into the hospital. If you are admitted into the hospital, a hospitalist will oversee your care while you are there. Now, this is just my health care system. The neighboring ones have not instituted this practice though my internist told me more and more health care systems will be as the years progress because it is becoming more and more popular. I was lucky though, I was still able to see my specialist while I was inpatient.

 

[Impromptu]

Many insurance companies are now requiring a capitation system, or are heading in the direction that shifts most/all of the risk to the doctors. They are doing this without an increase in compensation, which isn't fair. Those that have more risk should get paid more. So, it isn't surprising that people are moving the management of their practices to private groups or becoming hospitalists. That shifts the risk to a larger group that is better able to bear the risk. This does mean a slight pay-cut, but if you don't assume the risk, then a pay-cut should come. I think many will find this option attractive.

 

[deleted316655]

Why would you want a salaried job?

That means you have to report to a boss. Why not be your own boss?

You'll always have a boss, even if it isn't evident that you do. A salaried job has a lot of benefits that owning a practice doesn't have.

 

[smarty666]

You'll always have a boss, even if it isn't evident that you do. A salaried job has a lot of benefits that owning a practice doesn't have.

Not only that, but even if you are a doctor, like my internist, who owns and operates his own practice, you still have a boss, your patients. It is the patient who decides whether or not he or she will allow you to do the job (the treatment or procedure you are recommending) to them. Also, it is the patients who pay the private practice doctors salary, etc with their co-pays and insurance companies because, without patients the doctor would have no income.

 

[Ableton]

It depends on the specialty. The cardiologist is getting paid 400k+ to work for the hospital while bringing in 4x the amount his making. 400K+ is a good salary so I can see why some people will take it and run. However, if I were going into PCP(FM, IM) there is no way I can justified being paid 1/10th of what I bring in.

The only way I can do this is by having a one week on and one week off with the hospital. Use my off week for private practice patients to supplement my income.

The revenue a physician brings in for himself in a private practice will never come close to that for hospital. You're forgetting that the hospital makes a TON of money by charging for beds, drugs, equipment, nursing, etc. As well, there are many other physicians who will consult on the admitted patients, generating even more money.

In private practice, you will be looking at giving up around 50% of your gross revenue (maybe more or less depending on your business acumen). Throw in the fact that overhead is steadily rising while reimbursements are being cut - your profit margin is shrinking by the year. By the time you graduate and finish residency, it's quite possible that these salaried positions could wind up paying more than you would make working the same hours in private practice.

Times are changing. I for one think it will be interesting to see what happens.

 

[dru2002]

I do not know if I mentioned it earlier, but my health care system has done away with hospital call for all private practice internists and family practitioners who have hospital privileges at that hospital. That makes private practice GPs lives a lot easier. They are not allowed to see you if your admitted into the hospital. If you are admitted into the hospital, a hospitalist will oversee your care while you are there. Now, this is just my health care system. The neighboring ones have not instituted this practice though my internist told me more and more health care systems will be as the years progress because it is becoming more and more popular. I was lucky though, I was still able to see my specialist while I was inpatient.

I think that what you are describing is unfortunately about cash. If the hospital uses it own doctors the hospital makes more money than if they allow a PP physician to see inpatients. Kinda crappy but probably the reality.

 

[smarty666]

I think that what you are describing is unfortunately about cash. If the hospital uses it own doctors the hospital makes more money than if they allow a PP physician to see inpatients. Kinda crappy but probably the reality.

Oh I think you are exactly right and while I was shocked about this policy at first, in hindsight, I'm not surprised they did this. Also, not just for money but I think the hospital did this so that the hospitalist they are hiring have more patients and things to do because how are they suppose to do their job or any work if every single patients GP comes in and basically oversees and does their job for them? There wouldn't be any work for the hospitalist to do since the GPs would be running the show.

 

[smarty666]

The revenue a physician brings in for himself in a private practice will never come close to that for hospital. You're forgetting that the hospital makes a TON of money by charging for beds, drugs, equipment, nursing, etc. As well, Googlethere are many other physicians who will consult on the admitted patients, generating even more money.

In private practice, you will be looking at giving up around 50% of your gross revenue (maybe more or less depending on your business acumen). Throw in the fact that overhead is steadily rising while reimbursements are being cut - your profit margin is shrinking by the year. By the time you graduate and finish residency, it's quite possible that these salaried positions could wind up paying more than you would make working the same hours in private practice.

Times are changing. I for one think it will be interesting to see what happens.

I definitely think you have a great point here. I've seen over the years with my own medical insurance, how they keep paying and denying for more and more as the years go by. I have asthma and I cannot even get my insurance to pay for a seasonal flu shot, despite the fact I have a chronic condition. How does that make any sense? Regardless though, I just go to my county health department to get it and pay 15 bucks and that is that. I do not go to my doctor anymore for regular vaccines.

I think, if you are someone like me who likes the private practice life and atmosphere over working in the hospital all the time, the only and best way to even feasibly go into the private practice now is to go in with a large group that is owned by either the hospital or private company. Just my two cents. As others have pointed out, it just isn't feasible to start your own practice anymore. You just won't make that much money that way. Especially if you live in a state like me, NJ, where almost all taxes are sky high and a lot of NJ doctors, several surgeons in my areas I know of, are packing up their practices and moving across the river to PA in order to reduce their costs of practice. I'm talking neuro and orthopedic surgeons here, the guys who are making a fortune every year, who can't afford to keep their practices in NJ because of the taxes and fees. You know its bad when high paying specialties, such as those, are struggling to make a profit.

 

[FIREitUP]

Not only that, but even if you are a doctor, like my internist, who owns and operates his own practice, you still have a boss, your patients. It is the patient who decides whether or not he or she will allow you to do the job (the treatment or procedure you are recommending) to them. Also, it is the patients who pay the private practice doctors salary, etc with their co-pays and insurance companies because, without patients the doctor would have no income.

i would think the real boss is the government/insurance companies who tell you whether or not you will be paid or get authorization for procedures.

 

[FIREitUP]

reimbursements will only go down while the cost of running a business will only go up. that's the way of a physician's world.