by Michael F. Doherty, M.D.
From ATLANTA Medicine, 2011, Career Options in Medicine, Vol. 82, No. 5
Over the past decade, the number of physicians in solo practice, small groups and physician-owned practices has decreased while those working in hospital-owned practices, integrated delivery systems and larger group practices of various types have grown. The shift is driven by two factors — changes in the attitudes and expectations of experienced physicians and newly trained doctors eschewing the traditional model.
Why are experienced physicians leaving private practice? Regulatory and reporting requirements, costly office technology (such as EMR systems, billing and financial software), complex, risk-based compensation mechanisms, rising operating costs, and burnout from running a business in parallel with a clinical practice are the most often cited reasons. In addition, current economics make it challenging for physicians in solo and small group practice to work part time or afford a replacement partner in anticipation of retirement or limiting practice duties. Practice valuations have steadily declined, and selling a practice, if one can find a buyer, does not produce the financial rewards it once did.
In light of these conditions, experienced physicians are seeking employed status as their exit strategy from traditional private practice. Sometimes they are able to sell their practice to a local hospital system. Other times they simply shut their practice down.
The values, goals and demographics of younger physicians make traditional practice options less desirable. They are attracted to predictable hours, flexible work schedules, robust benefits and market compensation linked with professional business management. These elements are more likely to be found in integrated delivery systems, multispecialty groups, and institutional settings than in a small group practice.
New physicians will often have an easier transition to large multispecialty groups than experienced physicians. Experienced clinicians considering a change often wonder what to expect as they move from traditional private practice to a new work environment. How will they know if it will be a good fit for them? One of the biggest questions they have is, “How much control will I have?”
Certainly, the unbridled autonomy of solo practice will not be part of a large group practice. Still, physicians’ opinions will be highly respected and sought after, and a well-run organization will offer opportunities for influence and participation in decisions. Physicians could be involved in interviewing new hires for the staff they will work with, provide input into how night call is organized or negotiate with colleagues on how to best meet clinical responsibilities. They should also expect to be involved in the governance of the organization in a substantive way.
Clinical decision-making will also be different. In solo practice, quality care is“care as the physician sees it.” In larger practices, physicians are accountable to the group’s expectations for quality, service and use of resources.
Large groups usually set specific targets and provide data reflecting how you compare to other physicians with regards to access, screening for preventive services(like mammography) or achieving control of blood pressure. There may be minimum levels for these metrics that you’re expected to meet to remain in good standing in the organization.
Small and solo practices often operate with a physician-centric perspective, while large practices are more centered on patient needs. Established physicians will notice this subtle shift from having a team of people surrounding them to being part of a team surrounding the patient.
Physicians with interests that extend beyond the exam room will find many more opportunities in a large practice. Community involvement, research, clinical management, government relations, marketing, education and recruiting opportunities are often available and most large organizations support these activities through compensated, nonclinical time.
Large practices also provide a variety of prospects for those who want to experience a niche of clinical care that is not feasible given the time and resource restraints of a small practice. These may include areas such as sports medicine, palliative care, elder care, group or home visits and even telemedicine, all of which provide a satisfying complement to day-to-day patient care.
Of course, compensation is also a consideration. In general, compensation and
benefits in a large group setting are likely to be typical for the community. Compensation frequently is based on both individual contribution and the performance of the group. Elements of compensation extend beyond standard productivity measures to include patient satisfaction, utilization of in-house resources (like pharmacy and radiology), and meeting specific clinical outcomes.
Physicians are, by training and nature, resilient individuals, and almost any doctor can adapt to the large practice environment. Those who identify themselves as team players, evidence-based, practical problem solvers, and that see the value of consistent work processes, will find that a large group practice can be a satisfying career option. n
Michael F. Doherty, M.D., is a board-certified oncologist and Chief of Staff for the Southeast Permanente Medical Group, responsible for day-to-day operations management of the critical departments of care delivery for the group.