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Healthcare Practice Strategies - Fall 2014 - Employed Physicians: What to Do When It Doesn’t Work Out

Oct 28, 2014

This article is the fourth in a series exploring alternatives to the traditional private practice.

Many physicians have made the jump. They've gotten out of the business of running a private practice and into the business of being an employee. Others joined a hospital or health system as an employee right out of medical school — typically, younger physicians and female docs.

The Pursuit of Happiness

To be sure, many physicians are satisfied with their move. Whether it's a hospital, clinic, academic or government setting, they've found new lives as employed physicians.

But others are not so happy. A recent Medscape Medical News survey asked more than 4,600 U.S. physicians about their work environment and job satisfaction. Among physicians who moved from self-employment to employment, about 49 percent said they are happier now, while 25 percent said they were less happy. By comparison, 70 percent of doctors who moved from employment to self-employment reported they were happier, and just 9 percent said they were less happy.

Steady Paycheck vs. Autonomy

There are certainly pitfalls to becoming an employed physician. Although most practitioners probably expected some loss of autonomy and control, many have found the reality of answering to a boss tougher than anticipated. Less than half of employed doctors said they are satisfied with their degree of autonomy at work, while about a quarter are neutral and another quarter are unsatisfied, according to Medscape's 2014 Employed Doctors Report. Employed doctors complained about the profusion of rules and the lack of input into how they practice.

Other "negatives" with regard to employment reported in the Medscape survey included:

  • Limited influence in decision-making (45 percent)
  • More limited income potential (44 percent)
  • Too many rules in general (34 percent)
  • Less control over work/schedule (32 percent)
  • Being "bossed around" by management (30 percent)

Greener Grass

Thanks to technological advances, changes in care delivery and a shift in consumer expectations, employed physicians considering going private have plenty of practice options:

  • Direct Pay – Primary care providers charge patients a monthly fee that covers unlimited sick and well visits as well as basic in-house lab services. This model also includes direct contracting with employers.
  • Concierge – In this niche practice model, providers accept insurance but also require a set annual fee that covers services private insurers generally do not, such as comprehensive annual physicals, home or worksite visits, and even accompanying patients to specialists' offices. For that fee, patients typically are guaranteed same-day appointments and 24/7 access by cell phone and/or the Internet, as well as a host of services including basic blood tests, flu shots and yearly gynecologic exams.
  • Medicare Subscription – Similar to a concierge practice, providers apply an additional fee for Medicare patients to cover services not covered by their Medicare plan.
  • Telemedicine – Once the domain of rural care, telemedicine is gaining acceptance and popularity — especially in specialties such as psychiatry and oncology, and for specialty consultations. Accordingly, commercial telemedicine companies are developing new tools to help physicians develop a secure "telepresence" with their patients.
  • House Calls – Some providers are building practices solely on the house call model, targeting baby boomers with the income and inclination to seek in-home care. These providers accept payments via their smartphones or tablets and use a small or home office to complete paperwork and charting.
  • Nursing Home – Similar to the house call model, physicians see patients onsite at an extended care facility — again, not having to invest in a brick-and-mortar office.
  • On-Call Specialty Practice – This model appeals to specialty physicians — typically surgeons, who utilize the office of the referring physician to see pre- and post-surgical patients.
  • Micro-practice – The ultimate "skinny" practice, a micro-practice entails a physician working lean and mean without any assistants. Using just a computer/EHR system and a single exam room, a micro-practice physician might see just eight to 10 patients a day.

Employee or Boss?

The push toward greater integration among hospitals and physicians has certainly led to a rise in physician employment. Yet, as Medscape's Employed Doctors Report clearly shows, many physicians have grown weary of working for others.

Fortunately, medical practice innovation — from solo micro-practices to patient-centered medical homes and direct pay practices — is one of the keys to private practice being a viable alternative to salaried employment.

Healthcare Practice Strategies – Fall 2014

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