Jan 3, 2012
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For surgeons in private practice, are the following the two routes to their practice?

1. Work for a large privately-owned clinic that has a few ORs with tens of other surgeons, making a salary and maybe make partner in a few years

2. Open your own clinic with a reception area and exam rooms only, either by yourself or with a few other surgeons, while having negotiated access to a local hospital OR

In the second scenario, how does it differ from just working for a local hospital entirely, thus seeing patients in their clinic in addition to operating in their OR?
 

Smurfette

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In the second scenario, the surgeon is not under pressure to cater to hospital administration and has his/her own autonomy with their schedule, case volumes, call schedule, etc., but pays their own overhead, malpractice and other expenses and can negotiate with local hospitals for call coverage, etc. Many surgeons have privileges at more than one local hospital, in order to maximize business. When you work for a hospital/system, the hospital can give parameters (must see x number of patients a week/do minimum number of cases per year, take X amount of call, participate in x, y and z, etc.) but the surgeon gets paid a salary or based on production as determined by contract (and does not typically pay for any overhead, malpractice or other expenses related to the practice). These surgeons are usually limited to one hospital, or to several hospitals with the same owners (usually not in the same town, but the hospital can "require" you to cover the other hospitals, depending on the language in your contract).

There are also private practices that are multispecialty groups, which is like #1, but with people in multiple different specialties (which can be just a few related specialties, or the whole range of fields, depending on the MSG).
 

Winged Scapula

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Smurfette has done a good job detailing the differences but I'll add a real life example:

One of our new partners left an employed position with a large national oncology group.

She was paid a decent salary there but had no autonomy in which hospital she used, where she referred her patients for medical and radiation oncology and had little say in how many patients she saw, how much vacation time she took etc.

Now in practice with our group she can go to any hospital she has privileges at, can refer to any medical/radiation oncologist in town, and of course, as long as she's not on call, can take as much time off if she wishes.

The major drawback has been that she saw very few patients in her employed position; not enough to run a successful private practice. Therefore the major transition for her has been to go from seeing more than 8 to 10 patients a day.
 
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Ibn Alnafis MD

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Smurfette has done a good job detailing the differences but I'll add a real life example:

One of our new partners left an employed position with a large national oncology group.

She was paid a decent salary there but had no autonomy in which hospital she used, where she referred her patients for medical and radiation oncology and had little say in how many patients she saw, how much vacation time she took etc.

Now in practice with our group she can go to any hospital she has privileges that, can refer to any medical radiation oncologist in town, and of course as long as she's not on call and take as much time off if she wishes.

The major drawback has been that she saw very few patients in her employed position; not enough to run a successful private practice. Therefore the major transition for her has been to go from seeing more than 8 to 10 patients a day.
When you, as a private practice surgeon, are on call, do you cover your patients and those of your partners only, or do you also provide coverage for the hospitals you are affiliated with?
 

Winged Scapula

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When you, as a private practice surgeon, are on call, do you cover your patients and those of your partners only, or do you also provide coverage for the hospitals you are affiliated with?
Our hospital call is considered "courtesy"; that means we can turn down new consults and are not required to see them. However, in our specialty, consults requiring an inpatient visit are not common.

General surgeons and others may be required to take call as part of being on staff.
 

Smurfette

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PP surgeons have coverage within their group (assuming they have partners) for their inpatients at all affiliated hospitals. In big groups, they may have different people cover each hospital. In smaller groups, it's usually one person covering all locations nightly. Most PP surgeons do not cross-cover patients of surgeons in a different group.

Each hospital has it's own call schedule that typical rotates between all the surgeons regarding coverage of patients coming in thru the ER (excepting those surgeons who have opted out of call, such as having courtesy privileges, or subspecialists who may cover their own patients but not take ER call). Usually in these environments, if there are competing surgery groups, a patient/patient's physician can request a certain group to take the consult, or it simply goes to the surgeon on call for the ER if the patient has no affiliation with a surgeon there. One of the PP hospitals I was at during residency had 3 competing surgeon groups; we always had to ask which group the consult went to (and then the person on call for that group was called), or if "unassigned" we sent it to the person on official ER call. At that hospital, certain PCPs were known to only have group x or group y see their patients, and messing up the consult patterns was considered a huge deal.

Of course, there is probably a fair amount of variation at the community level. Some places function where the person on call for ER gets all consults. Once again, this depends on referral patterns within the community, such as in locations where PCPs try to divvy up consults evenly between multiple surgeons/groups.

As WS mentions, some hospitals require surgeons to take ER call as a stipulation of maintaining privileges there. Some do not, or it is (sub)specialty-specific. Some hospitals are more flexible about this than others, and will negotiate terms to keep the PP guys on staff and bringing in business.

Hope this helps.