Is a Hospital-Employed Practice the Right Choice for You?

Vittaya Sinlapasart/123RF.com

Fair compensation, location, and practice type almost always round out the top three when it comes to signing on the dotted line for your next physician job. While compensation and location may be non-negotiable for many entering the job market, there is a quite a bit of wiggle room when it comes to practice type.

The nostalgic notion of the solo physician delivering babies and making house calls has been replaced by a dizzying array of practice types and patterns. For the first time in 2018, the percentage of physicians that were employed surpassed those who owned a private practice; currently almost 80% of young physicians under the age of 40 are employed. These changes aren’t happenchance and reflect a shift in the practice of medicine. Astute physicians will want to take a close look at what it means to be hospital-employed and if this practice type is the right career move.

You don’t want to be bogged down by the business of medicine

Many physicians chose medicine to care for patients and to stay on the cutting edge of medical innovation, not to focus on marketing or operations strategies. While many physicians in private practice eventually figure out a balance between the business and art of medicine, it is by no means a simple feat.

Choosing a hospital position allows you to leave the headaches of overhead costs and contracts to others who enjoy this work. Offloading this labor helps manage the ten plus hours the average physician spends on administrative duties and shift that time back to patient care, continuing education, and even (gasp!) a little more work-life balance.

Of course, choosing a hospital-employed practice doesn’t mean that you can completely ignore your future employer’s business plan. It’s up to you to inquire about the hospital’s strategic plan and ensure it is well thought out and will drive business forward. For example, physician job-seekers should check that there is a market for their unique skill set in the local community and that the hospital will support their new practice. Asking pointed questions about the hospital’s financial record and plans for expansion will allow you be confident that the administrators will do their job well, so you can do yours.

As with any large organization, hospitals have a number of policies and business rules that employees have to follow. Unlike private practice, where physicians make the policies, hospital leadership will often comprise a majority of non-physicians. Bridging the gap between business-minded professionals and physicians can lead to certain strife if there is constant turnover in the leadership or no real support for physicians concerns. Talking with current physicians or recruiters about the relationship between physicians and hospital management will help assess if a particular hospital-employed position will be a good fit for you.

You appreciate well-coordinated health care teams

Similar to work at a large academic center, hospital-employed physicians often have set avenues for collaborating with other physicians and health care providers. Since everyone is under the same umbrella, it’s relatively easy to coordinate your patient’s care and ensure that follow ups don’t fall through the cracks.

At large hospitals systems, you’ll likely be supported by a well-rounded group of ancillary staff— including physical therapy and rehabilitation services— that can be quite challenging to coordinate with the private-practice setting. It also tends to be easier to ensure that your patients’ care will be covered as they are staying within the same hospital system.

At its best, the large hospital system can recreate the easy flow of ideas and knowledge that is a hallmark of residency. Having a wide range of specialties under one roof that are easily available makes for a learning environment that is much more difficult to recreate in smaller practice-based groups in the community.

You enjoy being well-compensated— with a side helping of job security.

Currently, hospital-employed physicians are among the best compensated physicians, second only to young physicians in single-specialty practices. While these single-specialty practice physicians have higher salaries in their early years, hospital-employed physicians surpass them later on in their careers.

Moreover, as a hospital-employed physician, none of your compensation is funneled back into the practice to cover business expenses like overhead, marketing, or ancillary staffs’ salaries. Apart from Uncle Sam’s cut, your paycheck is all yours. You’ll also gain significant cushioning against job loss or a significant pay cut due to unforeseen business downturns like a new competitor in town or sudden insurance reimbursement changes.

New hospital-employed physicians should be aware, however, that compensation often goes hand in hand with productivity. While many physicians fresh out of residency will get a one or two year reprieve to meet productivity targets, most hospitals will eventually base physician compensation on meeting these targets.

Some physicians are concerned that reaching these productivity targets are unsustainable, leading to less face-to-face time with patients or even a drop in quality of care. It’s vital that you talk with current physicians in the hospital-employed practice to get an in depth sense of physicians’ recourse for managing productivity concerns.

Choosing the right practice type for you

Choosing your next physician job takes a bit of groundwork to make sure it’s the right fit. Don’t overlook the practice type when choosing a position— it can affect all areas of your work life, from the practice culture, your ability to provide quality care, and how your work is valued.

While younger physicians are more likely to choose hospital employment compared to their older colleagues, there are a range of personal factors that physicians should take into account when choosing practice type. Being honest about your clinical efficiency, ability to fit into a large multi-specialty organization, and your career must-haves will help determine if hospital employment makes sense for you.

Take the time to match your career goals with the practice setting, and you just might find that a hospital-employed position is your next best career move.