The third in a series on employment opportunities for physicians.
Faced with a wide range of social, economic and political challenges in the marketplace, a growing number of doctors and healthcare professionals are deciding there is strength – and professional advantages – in numbers. In the modern era, most physicians earn their living by practicing medicine in one of three primary employment disciplines: solo practice, hospital employment or participation in a group practice. All have advantages and challenges, but the benefits of an efficiently coordinated group are attracting interest and advocates in the healthcare industry.
“Group practice offers the best of all possible options at present,” said Dr. Angela Nunnery, a veteran of family medicine for 28 years. “Doctors in a group have the ability to have control over their clinical practice, but benefit from the support and shared responsibility of other physicians.” Medical group practices are typically alliances of physicians engaged in a particular medical discipline or a multispecialty group that works together for the common good. Members can be equity owners or employees of the group depending on the organizational structure. The benefits of a cooperative group effort are numerous, particularly the financial benefits. Members can share the cost burden of administrative expenses, such as accounting, administration, office equipment and support staff. Group practices are also in a better bargaining position than individuals when it comes to negotiating contracts and managed care rates.
Group affiliation also offers the advantage of consulting with one’s contemporaries. “Being part of a group provides resources you don’t have on your own,” said Dr. Linlin Liu, a medical oncologist. “You can bounce ideas off group members regarding tests, treatment options or specific situations you encounter.” Being in a group also provides the potential for a referral network. Competition exists in every industry and the medical field is no exception. Members in a group become familiar with other doctors in the organization and stand a better chance of referrals when appropriate.
“Multi-specialty groups offer mutual professional support,” said Dr. Christopher Robertson, a family practice physician for 14 years. “There’s mutual respect and good communication about how best to handle treatment options.”
Group practices also provide physicians with the ability to share the expense of new technology and medical equipment, allowing the practice to offer state-of-theart medical devices rather than hold onto older, outdated equipment until it is paid off by a single doctor in solo practice. Group practices can also invest in ancillary services that can be a source of additional revenue.
Dealing with expenses is important, especially for new doctors. After completing medical school and a residency program, most physicians are deeply in debt and don’t have the resources to launch and develop an independent practice.
And because most doctors do not have extensive training in finance, business administration and marketing – skills beneficial to establishing a successful business model – they are likely to seek employment opportunities with an existing structure or some sort of financial guarantee. Hospitals offer such arrangements, providing doctors with office space, administrative support and in many cases a salary guarantee for a limited time period. But some physicians say working in a hospital environment places limitations on how they practice medicine.
“Hospitals don’t have the best interest of doctors at heart,” said Dr. John Peet, a family practice physician of 40 years. “They want profit and they place restrictions and limitations on doctors and the way they practice medicine.”
Working in a structured hospital environment is fine for a doctor considering retirement in a few years, said Peet, but terms it a dead end for a physician building a career.
Steve Sanders, CEO of Memorial Hermann The Woodlands Hospital, disputes the notion saying hospital employment makes sense for a lot of physicians – though he acknowledges many doctors have a concern about losing their independence.
“Hospitals have to have standards and policies,” he said. “It’s an excellent environment for doctors starting out or those who want to focus on medicine, not administration and the business side of medicine.” Maintaining independence and having the ability to practice medicine on their own terms is important to many physicians. Solo primary care physician Dr. Abbas Jafri in Houston prefers the autonomy of his independent practice, but acknowledges it is not for everyone.
“It’s all about mindset and having an entrepreneurial spirit,” said Jafri. “You pay a price for being independent.”
Group practice can offer most of the benefits of a solo practice and the economic and administrative advantages of a structured employment position.
“You can have control over your clinical practice, but have a team to provide backup and support when needed,” said Dr. Nunnery. “You can focus on medicine and patient care. It’s an investment in yourself and your practice.”
And while there are economic advantages in the sharing of resources and expenses, ultimate success remains with the physician. An unproductive or inefficient doctor is not likely to be a welcome part of group practice for long.
Dr. Joel Kerschenbaum, a general practitioner for 38 years, said individual success in a group practice depends on how the physician runs his or her office. Purchasing power and shared expenses will not make up for a poor work ethic or inefficient practice.
Finding the right group is key. When evaluating affiliation with a medical group, it is important to understand the policies, structure, goals and mindset of the organization to make sure it is a logical – and economically viable – fit.
Prior to joining the group practice he is currently with, hand surgeon Dr. Mark Ciaglia was part of a private practice group. The experience with the private practice group was neither pleasant nor productive because the partners didn’t know how to integrate a new group member, he said. I was cheap slave labor when I started,” said Ciaglia. “It wasn’t a good situation.”
Ciaglia eventually left the organization and became a member of a multi-specialty medical group in The Woodlands. As a surgeon who depended largely on referrals, Ciaglia made a point of going to meet primary care physicians. He networked, offered his private contact information and offered to consult on cases where local doctors had questions.
“Being affiliated with the group practice enabled me to create awareness of my practice and get the support of local doctors,” said Ciaglia. “I’ve developed a busy practice – there’s a phenomenal difference in being with the right group.”
Dr. Liu believes group practice represents the best approach to medicine in the modern era and suggests that it is the future of medicine. Vertical integration of multispecialty physicians provides patients with more convenient, efficient and economical medical resources.
Kerschenbaum agrees, saying the complexities of practicing medicine are better served in a group.
“Group practice offers a lot of individual autonomy and the opportunity to be more successful as a group than any of us could be as an independent,” he said.