Private Practice AND Academics?

[medstudentmed]

Hi,

I was wondering how a hospital-affiliated private practice works. I understand that the hospital will fund new physicians starting a practice in turn for their services, but what does this entail? Is it solely on-call time?

Is it every possible to do both, private and academic? Say you have a private practice and do most of your surgical cases there, but also have an appointment at a university hospital where you can teach courses or possibly run a research lab?

Thanks!

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[SocialistMD]

Hi,

I was wondering how a hospital-affiliated private practice works. I understand that the hospital will fund new physicians starting a practice in turn for their services, but what does this entail? Is it solely on-call time?

Is it every possible to do both, private and academic? Say you have a private practice and do most of your surgical cases there, but also have an appointment at a university hospital where you can teach courses or possibly run a research lab?

Thanks!

I know it is possible to work at a community hospital affiliated with a medical school and residency. This will get you a dual appointment, but as to how much research you'll be doing, I'm not quite sure (then again, most people who go into private practice really don't have an interest in the basic science research component anyway).

 

[medstudentmed]

Thanks for the response. I was actually more interested in teaching / having resident rotate through--I would assume that this is easier to arrange than having a research lab at the university anyway..

 

[SocialistMD]

A great number of residencies are at community hospitals, meaning if you work at one of them, you will have residents (though, likely not medical students).

 

[Castro Viejo]

If you want to be a true academic surgeon, someone who practices surgery, has a true faculty position (as opposed to an adjunct position) where you're fighting for tenure, and conduct research in a lab or just produce clinical papers, then you're going to find yourself in academic practice at a medical school and its associated main "university" hospital. This means you'll be a salaried person associated with the medical school and a portion of your salary goes toward your time as a clinician/surgeon and educator/researcher.

As far as being in the community and having a private practice, I'm assuming you're talking about you OWNING your own practice outside of the medical school, that's unlikely as your position in academics will be consuming enough that you won't have time for such a venture and there may be some type of restrictive covenant on your practice within a certain geographic area that may compete with the university for the same patients. I'm sure you can see how you may have a conflict of interest as well, as you may shuttle patients with great insurance to your private practice and screw the university out of its due pay for your work (remember you're salaried by them).

You will see instances in which a medical school based group will provide surgical services at a community hospital. That is, someone on faculty at the medical school, salaried just like the person described above, who operates at a non-affiliated community hospital nearby. This has to do often with some kind of contract developed between the community institution and the medical school to have such a service provided. It's not a private practice, but rather, sort of the community hospital outsourcing its surgical staff rather than building its own.

Another way to go about this and be a pseudo-academician and be in private practice is to work at a community hospital that's university affiliated. Often the local university will send its medical students/residents over to your community hospital for training, you provide some sort of teaching, and they'll give you an adjunct professorship. So you can consider yourself "on faculty," but you're really not the tenured-type. Keep in mind that in the community, however, you won't be paid for anything more than what you produce in the operating room. So all those papers you're planning to write while in private practice that no one will pay you for (unlike in the university)? You'd be surprised with how quickly it loses its importance when you look at the time required.

My last point, the majority of General Surgery residencies in this country are based at community hospitals. My own program is a community program that's university affiliated. All my faculty are adjunct faculty at the local medical school. This is what you're going to see most of the time.

 

[Winged Scapula]

Hi,

I was wondering how a hospital-affiliated private practice works. I understand that the hospital will fund new physicians starting a practice in turn for their services, but what does this entail? Is it solely on-call time?

It depends on how you negotiated your contract. In *most* cases such as you describe, in which a local hospital helps you set up your practice or assists an existing practice to hire you, your only requirement is usually time. That is, they will require you to stay in the community and practice for a certain length of time, after which your "loan" (ie, start up costs, salary until you go to fee for service, etc.) will be forgiven. They CANNOT require you to only operate at their facility because you are not their employee, but rather either in solo practice or an employee of the practice you join.

Using my situation as an example:

- the hospital that is assisting my practice, loans me money for the salary guarantee, moving expenses, interest free, and loans the practice money to pay for my new computer, desk, credentialing and licensing fees, malpractice, etc.
- every month I work, 1/36 of that money is forgiven, so that at the end of 3 years, I owe nothing and can walk out, if I should desire, without any payment back
- I have no restrictive covenant
- I can apply for privileges and operate anywhere I want in town, but just their campuses
- I take no call except for my patients

Is it every possible to do both, private and academic? Say you have a private practice and do most of your surgical cases there, but also have an appointment at a university hospital where you can teach courses or possibly run a research lab?

Thanks!

As others have described quite well above, it is not practical to have a private practice and an academic practice which requires you to run a research lab. In general, your options are:

-straight private practice - group or solo
-straight academic practice - time in the lab will depend on what your contract states (ie, it may be split 70/30 clinical/research)
-community practice with an academic affiliation - you may have residents or medical students who rotate through; will most likely get an adjunct appointment
- community practice without academic appointment, perhaps in an HMO or VA facility, or other community hospital

Doing research in private practice is not practical because it isn't lucrative for the amount of work it requires. Some projects pay nothing, others only expenses and still others, a minimal stipend (ie, $1500). For large groups who can afford to hire someone (usually a nurse) who administers the protocol, manages the database and works with the vendors, patients and other research sites, it can be manageable and you'll see these private research companies all around larger cities - mostly testing stuff for Big Pharma. But most PPs I know do not engage in significant research because of the time and cost involved.