Choosing How You Want To Practice Medicine.

By Laura Freeman

Like most decisions, choosing whether you want to be part of a private practice, sell to an equity group, or become an employee of a medical facility has both positives and negatives. However, unlike choosing the color to paint your office, switching to a different structure for work can be difficult to nearly impossible if you change your mind. That’s why it’s so important to thoroughly consider everything, and make sure your colleagues are on the same page.

When John Cade, Jr, MBA, CFO joined Cardiology P.C. in 1990, most cardiologists in the area were part of a private practice. Today he is helping to manage one of the few, and possibly the only, cardiology practice in the area that is still private.

“The challenges in healthcare have become more complex, and so has everyday life. Achieving a balance, finding satisfaction in your work while still having time for a private life, can depend on how the business side of a practice is structured,” Cade said.

Recently many practices are either selling out to equity groups or coming under the wing of a hospital where physicians and staff work as employees. 

“This can ease some of the day to day financial pressure, get you home to dinner on time, and give you more certainty in planning your time off,” Cade said. “On the other hand, you don’t have as much autonomy in how you practice medicine, how much time you spend with a patient, and whether you can work in a patient who needs to see you today. 

“If you find you want to earn more to cover an unexpected expense or save for a special anniversary cruise, you may not have the option to see a few extra patients. The financial arrangement you agree to is what you’ll be paid, and you may or may not have the leverage to get a raise or say when or how much.

“For a practice with partners approaching retirement age, selling to an equity group may be an easier way for them to cash out rather than having to find financing or a new partner to buy them out.  However, changing structure could have a profound effect on other partners who will continue to work there. A good decision is one that works for everyone.

“As a practice grows, you’ll be adding new doctors. Young doctors with big student loans look for financial stability. This is where equity or hospital ownership has an advantage. It can take a couple of years for a new doctor to build a patient following to become a profitable contributor to the practice.

“Younger doctors are also tending to put a higher value on work/life balance and want to have more time for a young family. Instead of on-call nights and weekends, an equity group or hospital can hire someone to cover call hours.

“Concentrating staffing and resources is where equity and medical center groups make their money. Instead of three practices each having someone assigned to an administrative task, one employee may handle the same task for all three.

“That can reduce overhead, but it doesn’t allow for the fact that a well-trained employee who knows your practice and goes above and beyond to make your life easier and to look out for your patients could be worth more.

“Instead, you may have to settle for someone who is just good enough and willing to accept whatever the group is willing to pay. And you may not have as much say in staffing. If someone isn’t up to the job, replacing them can get complicated.

“The big advantage in private practice is autonomy. You decide how you want to practice, how many patients you want to see and how much time you spend with them, as well as when you’re willing to stay a few minutes late to work in a patient whose condition may not wait until tomorrow.

“You also have a say in who you work with, the staff you want working for you and how much you think they are worth. You decide how you want to grow your practice along with the systems and equipment you prefer to use.

“The other side of it is if you want new equipment, you’ll have to budget for it. Instead of a hospital directing new patients your way, or an equity group with a promotional budget, you’ll be responsible for building a referral network and getting your name in front of other physicians and patients. If you need a lawyer or accountant, you’ll have to hire one, and you’ll have to staff for all the support tasks that have to get done.

“The big issue is managing your time so you still have a life. In private practice there’s a sweet spot of around five to ten physicians so that you have enough people to share on-call without nights and weekends becoming too much, yet without so many people that scheduling becomes complicated. There’s also nothing that says a private practice can’t recruit someone to cover at least some of the on-call hours.

“The two primary considerations are knowing what you want out of your career and your life, and honestly assessing what type of person you are. If you have the heart of an entrepreneur, can you also see that the bills get paid or hire someone who will? Or would you rather go home at 5:00 and not have to think about work until the next day?”

Knowing yourself and what you value are the keys to designing a professional and personal life that works.