What's it like to work for Kaiser as FP doc?

[lindyhop]

Anyone has first-hand info about this? I seem to hear mix things. On one hand, people say you have this huge patient load and have to see patients in like 6 minutes, on the other hand, I've also heard Kaisers treat their doctors well.

I'm still in med school, but I'm just thinking ahead... Also what resources do people use when searching for jobs after residency?

Thanks for any comments!

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[deleted87716]

I seem to hear mix things. On one hand, people say you have this huge patient load and have to see patients in like 6 minutes, on the other hand, I've also heard Kaisers treat their doctors well.

Consider the source. Hypothetically, if the doctors are saying the former, and the company is saying the latter, well...

And "treated well" sounds like a backhanded compliment...isn't that what former hostages usually say about their kidnappers? 😉

 

[Jack Daniel]

KentW made a comment a week or so ago, in a different thread:

"Physicians who are employed by HMOs are essentially at the mercy of their employer. .... The happiest and best-paid physicians I know are in private group practices. The lowest-paid and most miserable work as salaried employees of large health systems. The reasons for this seem obvious to me."

His comment makes a lot of sense to me. It seems very applicable to this thread, too.

 

[deleted87716]

KentW made a comment a week or so ago, in a different thread...It seems very applicable to this thread, too.

I'm not necessarily slamming Kaiser or any particular HMO, mind you, but I'm a big proponent of physician autonomy and independence. 🙂

 

[deleted6669]

I have worked for kaiser in the past and still have many friends there.
the work load is rough with a pt every 15-20 min + add ons/overbooks.very little in the way of procedural medicine unless you also do some shifts in urgent care.
referals are easy because kp has all their own specialists.
pay is slightly better than avg as are benefits and retirement.
they have something called "the rule of 80"- when your age + your yrs of service = 80 you can retire on half salary for life so if you are making 160 k/yr this = an 80k/yr pension...not too shabby. of course to get this you have to work your whole career there. they also have a 401k type benefit for folks who don't qualify for rule of 80( and those who do).they also give outrageous vacation that stacks pretty quickly. 3 weeks to start and 12 weeks by yr 12. cme also escalates yearly. they also have a sabbatical benefit that is pretty cool. 1 month/yr cumulative. so a doc there for 12 yrs can take a yr off at half pay and retain all benefits....pretty cool.sick time and vacation time accumulate until used. when I left there I had over 400 hrs of unused vacation on the books that they cashed out.
most kp fp docs do not have a hospital practice unless they elect to work on the hospitalist service so this is basically an outpt position. do not work at kp if you don't want to work with midlevels. kaiser uses pa/np/crna folks all over the place including working as pcp's doing exactly the same things as the fp docs( for less money of course) including running their own panels, etc.
hope that helps....basically it's a comfortable position with good benefits at a fairly hectic pace.

 

[deleted87716]

the work load is rough with a pt every 15-20 min + add ons/overbooks.

That's rough? 😕

In an eight-hour day, that's only 24-32 patients, assuming no extra time is allotted for new patients, physicals, etc. I typically see around 25 per day, maybe 30 on a day with a lot of work-ins. The people I know whom I consider very busy are seeing 40-50 patients a day. Ouch.

 

[deleted6669]

That's rough? 😕

In an eight-hour day, that's only 24-32 patients, assuming no extra time is allotted for new patients, physicals, etc. I typically see around 25 per day, maybe 30 on a day with a lot of work-ins. The people I know whom I consider busy are seeing 40-50 patients a day. Ouch.

they often have many overbooks and end up doing their charting and other paperwork before work, during their unpaid lunch or after work off the clock. they do not get extra time for new pts/gyn visits/physicals/L+I cases etc
when I worked there( in em) I made more money (as a senior pa) than the fp docs who worked a lot harder than I did. they showed up an hr early and left an hr late every day.they also have an emr system there that pretty much requires you spend more time typing than seeing pts. everything is done through the computer; referals, rxs, disability paperwork, etc....oh yeah the system frequently crashes and then you have no idea what your schedule is for the day, no access to old charts which are all computerized, no access to specialty on call lists, etc...when the system works well there it is fairly smooth. when it breaks down it really sucks.
I would not work there as an fp doc because I would not have the ability to do any procedures, would not get a production bonus, and would work with pa's/np's doing exactly the same thing that I was doing- not to bash pa's( I am one) but if I went back to school for 7 more years I would want my job to be different than the pa working in the next office, not just pay more.

 

[jsaul]

living in Cali, I know a lot of docs that work for kaiser....

let me tell you-- no one can beat their benefits...The guy who listed their benefits is right...

If you work your whole career there as an FP once you retire-- you make half your salary for life. Most docs who start their career at kaiser end up retiring in their mid 50's making at least 80,000 a year for the rest of their lives after retirement---.. think about that. You get unreal amount of vaca...


the downside of all this... autonomy

 

[deleted87716]

If you work your whole career there as an FP once you retire-- you make half your salary for life.

That's the way things are now. Who knows whether or not those pension benefits will survive for the next 20+ years? They haven't for a lot of other companies. It's still a good idea to plan for your own retirement, apart from any promised pension benefits. Because you just never know.

My father worked for IBM for 30 years, which was the granddaddy of all companies in terms of benefits and taking care of employees. Never a layoff in their entire history, killer pension plan, etc. Well, those days ended in the early 1990's. IBM's no different from any other tech company now.

Where big companies are concerned, what's good for the company will always trump what's good for the individual. You have to be comfortable with that if you're going to work for a large corporation.

 

[skypilot]

That's the way things are now. Who knows whether or not those pension benefits will survive for the next 20+ years? They haven't for a lot of other companies. It's still a good idea to plan for your own retirement, apart from any promised pension benefits. Because you just never know.

My father worked for IBM for 30 years, which was the granddaddy of all companies in terms of benefits and taking care of employees. Never a layoff in their entire history, killer pension plan, etc. Well, those days ended in the early 1990's. IBM's no different from any other tech company now.

Where big companies are concerned, what's good for the company will always trump what's good for the individual. You have to be comfortable with that if you're going to work for a large corporation.

Yeah, I heard Worldcom, Digital, Wang, Enron, and Arthur Andersen all had excellent pension plans too! 🙂

 

[lindyhop]

Thanks for all the input! This forum sure has lots of good info!

So, another question... what then is an ideal working environment for FPs if one wants more autonomy? Group practice?

And I'm also wondering how important is it to work at a place that has a good electronic chart system. I imagine have such a system would be more time-efficient because there would be less time spent hunting down information like lab and imaging results, or a consult note. But then I wonder if most group practice can afford such an electronic charting system...

 

[deleted87716]

what then is an ideal working environment for FPs if one wants more autonomy? Group practice?

Well, everyone has their own idea of what's "ideal." I'm sure that for a lot of people, working for an HMO is their idea of an ideal practice arrangement. However, one of the biggest factors in physician job satisfaction is the physician's ability to have control over his/her practice. I think that's much more likely in the private practice setting, whether it's with a group or solo.

And I'm also wondering how important is it to work at a place that has a good electronic chart system.

I've used both, and prefer electronic medical records (we're using paper charts now, but my residency program used an EMR). However, they can be an expensive boondoggle if not implemented correctly, and there are lot of things up in the air right now regarding standardization and Medicare pay-for-performance that could have a profound effect on the market. It's probably not a good time to buy an EMR.

 

[FPforLife]

It's probably not a good time to buy an EMR.

I have to disagree with Kent W on this one. EMR more than pays for after a few years. The transition is sometimes difficult at first for staff but after a couple of years the staff and physicians I know who have switched over say they would never go back.

Here's why. First it makes the record much more organized(less likely to lose things in the paper shuffle). Also it tends to speed up pt encounters because you don't have to waste time sifting through the chart looking for labs and if your like the FP clinics here, scripts go directly to the pharmacy. Nice for you and the pt. A few taps with the stylet and your scripts are done. And of course the biggest reason is $. The computer will calculate what type of visit you have done and tell you how to code. This eliminates over and under coding. The doc here I spoke with told me he is making alot more money because he is correctly coding.

The down side is the initial cost which is usually about $10,000 per provider

 

[lateness]

It's probably not a good time to buy an EMR.

I have to disagree with Kent W on this one. EMR more than pays for after a few years. The transition is sometimes difficult at first for staff but after a couple of years the staff and physicians I know who have switched over say they would never go back.

Here's why. First it makes the record much more organized(less likely to lose things in the paper shuffle). Also it tends to speed up pt encounters because you don't have to waste time sifting through the chart looking for labs and if your like the FP clinics here, scripts go directly to the pharmacy. Nice for you and the pt. A few taps with the stylet and your scripts are done. And of course the biggest reason is $. The computer will calculate what type of visit you have done and tell you how to code. This eliminates over and under coding. The doc here I spoke with told me he is making alot more money because he is correctly coding.

The down side is the initial cost which is usually about $10,000 per provider

sounds like it is worth it.. 👍

 

[deleted87716]

I have to disagree with Kent W on this one.

If you're going to disagree with me, at least disagree with something I've actually said. 😉

I never said EMRs weren't a good thing. In fact, I said the exact opposite...that I preferred them to paper charts. However, I don't think right now is a particularly good time to jump into the fray.

The down side is the initial cost which is usually about $10,000 per provider

Realistically, it's at least double that. There are fifty docs in my group. Do the math...that's a million bucks (the estimates we've received from vendors are actually higher than that). Nobody's going to spend that kind of money lightly.

EMR more than pays for [itself] after a few years.

Unfortunately, many of the cost justifications the vendors like to use (saving on transcription, improved coding, etc.) don't apply to us. Most of us don't use transcription, and we're already coding very accurately (we monitor our coding and documentation with periodic internal audits.)

Again, I'm a huge EMR fan. I've already used one and am well aware of the benefits. However, the financial investment is not insignificant, and the payback period is not necessarily short.

 

[FPforLife]

I see what your saying. My only question is do you for see the price getting cheaper in the next few years. Also I've heard mention of grants becoming available from the federal gov't to help with start up cost? Especially since hurricane Katrina. Is that true? My last question do you think EMR will be mandatory w/in the next 10 years?

 

[deleted87716]

do you for see the price getting cheaper in the next few years.

Yes. In fact, we're banking on it (literally). 😉

Also I've heard mention of grants becoming available from the federal gov't to help with start up cost?

I haven't heard that. If you have any additional info, I'd be interested. The government's backing of the Vista EMR used by the VA system seems to be their primary focus. Of course, that rollout is having its problems, as expected.

do you think EMR will be mandatory w/in the next 10 years?

If not mandatory, than at least very hard to do without.

 

[sophiejane]

Also I've heard mention of grants becoming available from the federal gov't to help with start up cost?

These are available for starting federally-recognized rural health clinics in designated medically underserved areas (which fortunately for me but unfortunately for the patients is most of my state).

 

[FPforLife]

Ya that's right. Federal grants to help fund EMR, at least for now, are only available for rural or underserved areas.

 

[ramonaquimby]

bump for more Kaiser opinions! 😉

 

[Joe Richards]

Consider the source. Hypothetically, if the doctors are saying the former, and the company is saying the latter, well...

And "treated well" sounds like a backhanded compliment...isn't that what former hostages usually say about their kidnappers? 😉

lol. large hmo holds doctors hostage as they are made to do excessive work with sub-standard medical software. Specifically the save data button is made to malfunction and they are forced to see the patients over and over again as a common hmo torture method known as "one complaint per visit".

 

[Joe Richards]

living in Cali, I know a lot of docs that work for kaiser....

let me tell you-- no one can beat their benefits...The guy who listed their benefits is right...

If you work your whole career there as an FP once you retire-- you make half your salary for life. Most docs who start their career at kaiser end up retiring in their mid 50's making at least 80,000 a year for the rest of their lives after retirement---.. think about that. You get unreal amount of vaca...


the downside of all this... autonomy

With proper financial planning you can do that in your own private practice. You don't need Kaiser to do it.

Even someone with an annuity and an initial lump sum of 2000000 can make 80 K per year for life.

You get the 2000000 by properly investing during your career.

That's how Kaiser gets to give you 80K per year after you retire.

 

[futuredo32]

I'm not necessarily slamming Kaiser or any particular HMO, mind you, but I'm a big proponent of physician autonomy and independence. 🙂

I'm just curious. In what way does Kaiser or any HMO limit a physician's autonomy and independence?

Also, I like the Santa-themed blue dog, very festive.🙂

 

[deleted87716]

I'm just curious. In what way does Kaiser or any HMO limit a physician's autonomy and independence?

It's not just Kaiser. Anytime you're working for somebody, well...you're working for them. What more can I say?

 

[secretwave101]

I'm just curious. In what way does Kaiser or any HMO limit a physician's autonomy and independence?

I spend a lot of time at Group Health, which is an HMO in the PacNW very similar to Kaiser. The autonomy thing is THE biggest thing holding me back from working for them. They're great, and I may end up there, but the lack of freedom is really tough.

For one, your employer is miles away, often not a doctor. They're often off counting beans (aka, RVU's) and calculating how many they can squeeze out of you. Also, the staff don't work for you, they work for that same dude nobody really knows. They give the docs I've worked with waaay too much attitude, especially when the doc falls behind.

You also have much less control over your schedule. In residency, pretty much nothing bums me out more than when a pt. is added in at the last minute, especially a complicated one. This happens all the time for me and I'm looking forward to getting some control over it once I'm out. Until you've had it happen to you, it's hard to explain how frustrating the experience is. In a private setting, taking someone on is TOTALLY up to you, and you get paid extra for doing it. In a HMO setting, it has nothing to do with you. And, in the opposite situation where you want to take an extra patient on, the staff get all mad at you because they want to go home. Their salary isn't improved by that last patient.

Also, upper management can implement anything they want at any time. The latest at Group Health is to allow the sun to rise and set on the smooth, curvy butt of Press-Ganey scores. These are *****ic patient satisfaction surveys that are so totally influenced by confounders that nobody in their right might would REALLY use the scores as actual data. But somehow the medical community is doing just that. At the HMO, your SALARY is tied to these scores. You can lose money if you spend your day telling pt's no to narcs and antibiotics and the satisfaction scores drop.

There's more, but those are the ones that jump to mind.

Crap. I just talked myself out of Group Health. 😱

 

[Joe Richards]

I spend a lot of time at Group Health, which is an HMO in the PacNW very similar to Kaiser. The autonomy thing is THE biggest thing holding me back from working for them. They're great, and I may end up there, but the lack of freedom is really tough.

For one, your employer is miles away, often not a doctor. They're often off counting beans (aka, RVU's) and calculating how many they can squeeze out of you. Also, the staff don't work for you, they work for that same dude nobody really knows. They give the docs I've worked with waaay too much attitude, especially when the doc falls behind.

You also have much less control over your schedule. In residency, pretty much nothing bums me out more than when a pt. is added in at the last minute, especially a complicated one. This happens all the time for me and I'm looking forward to getting some control over it once I'm out. Until you've had it happen to you, it's hard to explain how frustrating the experience is. In a private setting, taking someone on is TOTALLY up to you, and you get paid extra for doing it. In a HMO setting, it has nothing to do with you. And, in the opposite situation where you want to take an extra patient on, the staff get all mad at you because they want to go home. Their salary isn't improved by that last patient.

Also, upper management can implement anything they want at any time. The latest at Group Health is to allow the sun to rise and set on the smooth, curvy butt of Press-Ganey scores. These are *****ic patient satisfaction surveys that are so totally influenced by confounders that nobody in their right might would REALLY use the scores as actual data. But somehow the medical community is doing just that. At the HMO, your SALARY is tied to these scores. You can lose money if you spend your day telling pt's no to narcs and antibiotics and the satisfaction scores drop.

There's more, but those are the ones that jump to mind.

Crap. I just talked myself out of Group Health. 😱

Don't you just love SDN. In the time it took you to write that post you were able to make a life changing decision. Now that's what I call efficient.

 

[deleted87716]

Don't you just love SDN. In the time it took you to write that post you were able to make a life changing decision. Now that's what I call efficient.

Secretwave is spot on, however. That's exactly the stuff I was referring to.

 

[futuredo32]

Thanks for describing some of the less desirable parts of working for an HMO. It's a lot worse than what I had imagined. (Especially the patient satisfaction surveys. The Dr. who gives out narcotics freely and contributes to antibiotic resistance is probably the doctor of the year 🙄 )

 

[Joe Richards]

Thanks for describing some of the less desirable parts of working for an HMO. It's a lot worse than what I had imagined. (Especially the patient satisfaction surveys. The Dr. who gives out narcotics freely and contributes to antibiotic resistance is probably the doctor of the year 🙄 )

There are many doctors who don't care much about the autonomy issue as long as they can come to work get paid and focus on their private life. You can do that in a large group as well but some doctors just don't want to deal with any hassle.

FP is very broad. that is an advantage and a disadvantage. I like to think it is more of an advantage.

I don't think in the future the HMO's will have the capability to do what they do now. They are making changes to keep up with the coming national changes in healthcare.

 

[burlypie]

Interesting thread...
I was just talking to my preceptor this morning, Kaiser FP about this very issue. He was in private practice 9 years before switching to Kaiser, was making about 77K yearly ("billing honestly" as he put it) and worrying about running a business.

Now at Kaiser he makes twice as much and only has his patient's medical issues to be concerned with - no increasing rents, billing, etc. He said switching was the best decision he ever made. True, he doesn't have the greatest MA (which he can't do anything about) but overall he's very happy.

 

[Good Solutions]

Now, step back and look at the big picture. If too many primary care docs work for HMOs or well, any one else there can be consequences. Losing the ability to open our own solo shops is akin to gutting the heart of the patient-doctor relationship. We will be like pharmacists. They used to own their own pharmacies and over the years they have all been assimilated by larger corporations. They are now pushing their students to learn clinical counseling to have something else to market, to try and reclaim their independence, their profession.

If we stop going into solo private practice the heart of the profession will be lost and patients will have no where to turn when things get worse.

 

[deleted87716]

^ Are you a physician?

Your sig block is larger than your posts. That's not usually a good thing...

 

[piggie]

dont work for kaiser
i went to a job interview with kaiser
and frankly, i was so disappointed with FP there
i dont even want to work for 'em

 

[dangit]

dont work for kaiser
i went to a job interview with kaiser
and frankly, i was so disappointed with FP there
i dont even want to work for 'em

can you elaborate?

 

[Birdeee]

I want to say at the beginning that I am not a med student (my husband is) but I lurk in the family medicine board as that is what he is interested in.

We have a friend that has been a doc for Kaiser for 22 years and loves it. He negotiated to spend half of his time in "alternative medicine" within the Kaiser system and during his clinic visits he is so familiar with the EFM (and he is a touch typist) that he does his charting during the visit and rarely has to stay late - although he has a "closed" practice. He wanted the benefits and realized that he was not a business person and he wanted to spend time with his family. He told me that the various Kaiser regions are very different personality-wise so you probably have to really understand what you want and what they can really offer you. He will retire from Kaiser with the pension and then accept one of the many small-group positions he has been offered and just invest his Kaiser pension.

That being said - health care is in such flux that you need to watch trends and options carefully.

 

[montessori2md]

Thanks for describing some of the less desirable parts of working for an HMO. It's a lot worse than what I had imagined. (Especially the patient satisfaction surveys. The Dr. who gives out narcotics freely and contributes to antibiotic resistance is probably the doctor of the year 🙄 )

This is true for private practice docs as well -the more narc pts you have, the more regular appts you have on the books, b/c they keep coming in for the meds, and you keep working them up for whatever it is this month (migraine? back pain? really bad cramps?). They can justify it by saying the pts would just order them online anyway🙁

I suppose this matters more if you're in an area where you're not swamped w/ pts every day no matter what.

More on topic, I know an NP w/ Kaiser making $99/hr in evening urgent care. BLS says average FP hourly wage is $73 and change (this is assuming you work 40hrs/wk 52 wks per year). I find that super-irritating, and on par w/ military MDs reporting to RNs who outrank them. Do I see how it can be rationalized? Yes. Do I want to go there? No.

That said, the referral system at Kaiser, and their administration in general, is very user friendly, speaking as a former patient.