The decision to go from your own practice to working for a group or a hospital requires thought and planning…and preparing for the worst.
Between an aging physician population, the high capital requirements of new technologies, and the lowering of physician payments, the number of doctors entertaining employment off ers from hospitals or practice groups is increasing. A 2011 MedSynergies study found that 70% of responding health systems and hospitals planned to increase their employed physician numbers over the next 36 months.
“Physicians are wondering more and more if they really want to worry about the business aspects of medicine,” says Mary Witt, senior vice president for the Camden Group, a consulting firm in El Segundo, Calif. “The complexities of running a medical practice have increased while reimbursements are going down and expenses trending up. Many doctors are wondering if it wouldn’t be best just to become an employee and focus on taking care of patients.”
What Do I Want?
There are many considerations in making the switch from self-employed to working for a hospital or large group. Most flow from you sitting down and fully answering the question “What do I want?”
“I talk about the Big Three of practice change,” says Nick Fabrizio, principal consultant with the Medical Group Management Association Healthcare Consulting Group headquartered in Englewood, Calif. “It is about compensation, control of your practice, and your fit with the potential partners. Once you peel away the onion around those issues, there are around 100 other things that will fall in line.”
He suggests a number of questions you should ask yourself. In many ways, compensation may be both the easiest and more challenging part of the discussions. You have to not only look at and understand what you will be paid but also how. Are there any performance standards that might impact the size of your check? What is the amount of your salary, and exactly what are you expected to do for the paycheck?
You will probably have the equivalent of a job interview with the people you will be sharing your office with. You should also interview them as if they were coming to work for you.
The issue of control is another one that a physician should sit down and think long and hard about. Will you still be able to practice the way you are now, or will there be constraints put on you by the policies of the employer? How many patients will you be expected to see? Can you stay in the same office, or will you have to move? What is the status of your staff , and will they be able to come along? Can you tolerate no longer being the captain of your own ship?
The importance of addressing these questions and making sure you are comfortable with the answers is reinforced by another concern. If you enter an employment situation and are not happy, it is much more difficult to go from employed back to self-employed.
Hard To Go Back
“One of the biggest barriers to transition back is getting the capital required to start a new practice,” Witt says. “You have to cover renting and equipping an office, hiring staff, and covering cash flow needs while you build up the practice.”
A part of the change that may not be immediately recognized when doing your planning is that most of the infrastructure you rely on will disappear. You will have to work out new referral patterns and negotiate payer contracts. With the rise of narrow networks, there is a chance that you will not be able to retain all of your patients. In addition, you no longer have the clout of a group when negotiating with insurance companies.
“Another consideration is ownership of the medical records,” Witt says. “In most cases, they will belong to the group, and you won’t be able to automatically take them with you when you leave.”
Many physicians do not take into consideration non-compete agreements. Depending on the contract and local law, you may not be able to practice within a 30-mile or more radius of the group for up to two years. This gives the twin concerns of how do you make a living for that time and how many of your patients will want to find you when the agreement has expired.
Extricating yourself from a bad situation may be easier if you are going from one group to another. You may get a better environment while still retaining the infrastructure and capital clout that isn’t available among the self-employed.
Although it may seem as though you are preparing to fail, experts agree that it is often in your best interests to include exit strategy considerations in all phases of the change.
“This is a very long-term decision that is very hard to reverse,” Fabrizio says. “You need to be 100% sure that this is what you want to do before you do it.
— Ullman, RN, MHA, is an Indiana-based freelance writer
with nearly 30 years of experience. He wrote about enhancing
nurses’ job satisfaction in the January issue