You have studied and trained in your specialty and now you are ready to define your career path. The question is where, how, and with whom? These can be difficult questions to answer and yet, they are some of the most important decisions you will make in your career. Selecting the right environment to launch your medical practice is a milestone. Like all other journeys in life, this one begins with a single step- answering one question at a time.
The best way to decide where and how to practice medicine begins with simple, yet profound questions. We are going to pose them here to walk you through a quick examination of your preferences; rural or urban location, small practice or academic teaching center. Job satisfaction and self-fulfillment are important to an enduring career; finding them requires genuine answers that reflect your goals and expectations, not others.
Where do you picture yourself practicing?
- In a small farming community where you are the only physician with a small patient panel?
- In a suburban area with a young professional vibe and a growing group practice?
- In a city with an urban lifestyle where you can be part of a vibrant academic teaching hospital?
Try each of these on for size mentally. Think about what feels best and what fits.
Now let’s move on to the size of the practice you prefer. Do you see yourself working:
- In a solo practice that offers control over all business functions, with a small patient panel?
- In a large physician group, where your individual patient panel is large, but other responsibilities like the call schedule are divided across a larger pool of physicians?
- As an employed physician of a hospital, or practicing as a hospitalist?
- As a traveling physician, working in different geographic locations and experiencing diverse medical practice as a Locum Tenens?
Once you have answered these questions, it’s time to connect the dots. These details will guide your research and job applications. The good news is that there are no wrong answers. Physicians across the country are working in both situations.
In its most recent survey of physician practice arrangements, the American Medical Association (AMA) found that the majority (60.7%) of physicians were in small practices of 10 or fewer physicians, and the majority of those practices (56.8%) were wholly owned by the physicians. According to the AMA report, “The share of physicians who worked directly for a hospital, or in practices that had at least some hospital ownership, increased from 29 percent in 2012 to 32.8 percent in 2014.” The size, shape and location of the practice you prefer exists; only market conditions will restrict your ability to find a job.
You can easily find evidence to support the advantages or disadvantages of any particular practice model – depending upon the satisfaction level of the practitioner who is discussing it with you. Here is an objective look at the pros and cons of different practice types, with information from the American College of Physicians.
Solo Practice
A practice without partners or employment affiliations with other practice organizations, with a small staff.
Pros:
- Autonomy in business, practice style
- Smaller, more personalized patient base
- May be able to affiliate with local hospitals, gain business support (i.e. financial, electronic medical record support, etc.)
Cons:
- Full burden of running the practice rests on sole practitioner’s shoulders
- Practitioner full responsible for contracting with insurers, compliance documentation, billing etc.
- Substantial financial risk, lost income caused by illness or vacation, burden to pay education debts and business costs
Group practice
Typically divided into single-specialty and multi-specialty practices with two or more physicians.
Pros:
- Increased financial security, more employee benefits.
- Better control of lifestyle due to larger number of physicians
- Better management of practice financial risk due to size
- Business manages administrative tasks
- Increased number of physicians spreads the burden of call
Cons:
- Autonomy and decision-making ability decrease
- More bureaucratic and policy driven
- Larger patient pool can lead to less personalized practice
- Potential for conflict with colleagues/partners over delivery of care
Employed Physician
This model can include working for a practice that is owned and managed by a hospital, working directly for the hospital, or working for a group practice that employs physicians in a corporate structure.
Pros:
- Administrative burden of running a practice rests solely on the employer
- Physicians can focus more on practicing medicine
- Baseline level of compensation is contracted
- Reasonable coverage for clinical responsibilities/patients and better control of lifestyle
- More opportunities for further education and training
Cons:
- Productivity demands and incentives may be significant
- Physician autonomy may be substantially diminished
- Scheduling, policies and procedures are generally set at the employer level
- Delivery of care must adhere to corporate policies and procedures
Locum Tenens
These positions are temporary, running from a few weeks up to a year, offered by practices, hospitals, or healthcare organizations that have an unfilled clinical need.
Pros:
- The compensation rate is higher than that of permanent positions
- Offers the opportunity to experience different practice types and locations
- No commitments to long term employment
Cons:
- Travel, living in unfamiliar places
- Working with people/culture/internal politics you don’t know
- Length of assignment is usually fixed, not variable according to personal need
The AMA recently conducted a survey, 1 of 30 physician practices in 6 US states to answer the question, “What factors influence physician professional satisfaction?”. The AMA-RAND study highlights major contributors to higher professional satisfaction, including: providing high-quality patient care, autonomy over day-to-day work and sharing values with practice leadership. This led researchers to wonder, is physician satisfaction with their work an overlooked factor in increasing the delivery of quality healthcare?
It’s not a far reach to say that your ability to find satisfaction in your medical practice is one of the lynch-pins of improving healthcare in the U.S. Listen to your priorities. Find them and in the process contribute to a better functioning healthcare system.