What have we given up?
I have been an employed physician for going on 15 years and an independent contractor for a handful. I enjoyed the contract years the most, but it was not a settled lifestyle and something told me to do what everyone else was doing. You know, settle down, get a job, travel on two weeks off a year like the rest of humanity.
Teaching was fun and it could only be done in a large institution. Eventually, I settled for a large University setting in the south. Yes, my ego was part of it. Everyone in the region was always impressed by credentials as a professor from the Harvard of the South. After all, I had come from the Harvard of Canada. (I won't dwell on the sarcastic undertone, but if it is subtle, please note it!)
The main arguments for a physician to enter into an employment agreement are for lifestyle (you don't have to cover everything in your practice), convenience (no hassle of being responsible for your own books, payroll and so on) and for leverage (negotiating better terms with insurances.) Maybe there are others and you're free to add them.
But that means you have to give up some autonomy. Unlike the rest of the work-a-day world, I wonder if physicians expect to continue having all the freedoms they associate with their own practices: make your own schedule, close up shop as needed according to immediate priorities, refuse to take direction to meet the needs of the organization...
Most administrations are respectful of the fact that their physicians and other providers are the backbone of any clinical services organization. Of course I have met some pretty untrustworthy people and entities along the way, full of backhanded politics, unreasonable requests and frank incompetence.
But my question is what did the physicians expect when they entered into employment agreements???
Tuesday, May 20, 2008
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3 comments:
Do you see employment agreements with institutions heading in a particular direction.... or can you comment on how the relationship has changed in the past 5-10-15 yrs btw physicians and hospitals?
I am thinking about the benefits/drawbacks of working in an institution for myself as I begin my residency this year. It would be great to get your thoughts on that topic.
Thanks for posting this.
Sonya Lazarevic MD
At the peak of the 90's managed care craze, everyone was busy buying up practices for inflated prices and with few clauses to ensure the financial solvency of the practice. The managed care bubble bust and a divestiture followed. Over the last 5 years or so, more and more hospitals have employed physicians, both for hospital-based services (e.g. hospitalists) and, especially in smaller towns and rural areas, hospitals have been busy employing ambulatory physicians.
The major benefit to the physician is the low level of management headache. Physicians have been notorious for not running their practices like businesses. The drawback is that most professional managers have no clue what medicine is like and do not often have the insights required to make good long-term business decisions for the practice without hurting quality of care and physician job satisfaction.
Part of my point is, if you are not ready to be a good soldier and be patient in the face of decisions you find dubious, perhaps an employed position is not a great idea.
On the other hand, there are large physician-owned and controlled practices that are better positioned to make the "right" compromises, not harming patient care for expedience.
The right choice involves clarity and insight into in your own personality and tolerance and character. I know (and envy) some people who will be happy in nearly any situation!
Good luck.
wow, thanks!
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