I cannot believe how many new grads or rad oncs otherwise only want to be employed. I looked at a hospital based practice with strong volume that had been operating on a PSA agreement for decades. Docs were retiring. I was the only doc the hospital spoke to who wanted to maintain an exclusive PSA. Everyone else they interviewed wanted to be employed. I knew what they were willing to pay vs prof collections. I just don’t get the desire for hospital employment in situations where you’d “win” being independent.
I honestly don't know how many residents could read your post and understand what you're saying. If I went around the country and asked every Radiation Oncology resident (or, I guess, any resident) what it meant that a group had been "operating on a PSA for decades", how many do you think would know what I was talking about? 50%? On a good day?
Therein lies the issue, and why we have been absolutely manhandled by the MBA's, or literally anyone with even a modest understanding of finance. Unless something has changed drastically since I graduated, there is absolutely no teaching of the financial side of healthcare in medical school. Kids probably have a vague understanding of what Medicare is, perhaps that it's different than Medicaid, maybe that there are different private insurance companies, etc. I certainly never learned anything about CPT codes, or what an RVU was, or that there were "professional fees" and "technical fees"...let alone that they were different.
Residency was only MARGINALLY better at explaining these topics. I think if you poll RadOnc residents about what RVUs are, they are likely to at least have heard of them because most of their attendings talk about them, but do they
really know what RVUs are, or why they're important? I would bet a lot of money most do not.
Many medical students have little work experience outside of academia (maybe they had a work-study staffing the library in undergrad). They know from watching friends and family that most people are employed by some entity and work in return for a paycheck. In residency, they get a flat salary from a hospital. They know their attendings also seem to get a base salary, and maybe a production bonus if they "generate enough RVUs by seeing more patients". They have been taught, either through passive-aggressive side comments or through outright contempt, that the doctors in private practice are just selling out for money. They have been warned about greedy private practice docs since Day 1 of medical school.
The undercurrent of "private practice bad, academia good" runs deep at every medical school in America. Impressionable medical students hear these sentiments and associate learning about the economics of healthcare with a sense of shame. If you mix all of these factors - zero formal financial teaching, shame in expressing interest in finances, and almost exclusively observing the model of doctors employed by universities and hospitals - you're going to breed generation after generation of new grads which think that employment is the only way to practice medicine.
In this current system we've created, with private insurance and CMS playing by different and complex rules, while the threat of malpractice suits loom around every corner, being employed by a hospital is BY FAR the safest and easiest choice. You're still a doctor in America, so your income is significantly higher than most working adults, and most people are happy with that. However, you're choosing a path with a golden ceiling, and you're subject to the whims of hospital administrators.
Doctors like to think that we live in a meritocracy, that if you're smart and work hard enough you'll be OK, and for the most part the MBA's pay us enough that we don't think too deeply about it. However, there are 22 year old kids running around with more financial knowledge than 60 year old attending physicians, and that knowledge gap allows us to be taken for a ride time and time again.
