Medical Practice - Page 9
As with most issues, therefore, there are both
positive and negative sides to being a
member of a group practice. If you are
considering it, you need to be cautious and thor-
oughly evaluate the nature of the practice and
determine if you would be compatible
with the group members. Certainly you should be
the type of person who is a team
player before you enter any group practice;
however, the rewards of being a member of
a successful group practice can readily outweigh
its disadvantages.
Salaried Practitioners
These are physicians who work under contract for
private hospitals, governmental insti-
tutions (hospitals, clinics, or agencies),
commercial, industrial, or insurance companies
or HMOs (see below), and receive a fixed
remuneration for their services rendered
over a given amount of time. This type of
practice is especially appealing to those just
beginning their practice. Over half of those
completing their postgraduate training begin
this way and many move on to solo or group
practices.
The advantages to those starting a medical
practice as a salaried employee are clear.
The principle reason given by many is to avoid
the financial strain of having to cope
with a relatively low income for many months
when beginning a new solo practice and
taking the gamble of succeeding, especially at
a time when the new practitioner is per-
haps still burdened by heavy student loans. It
is extremely challenging under these con-
ditions to have to sign an office lease, order
furniture and equipment, engage a staff, and
arrange for the many other requirements a new
solo practice mandates.
A further element influencing a physician's
career planning at an early stage is the
knowledge that national economic trends, such
as inflation and depression, as well as
such issues as personal and professional
contacts, can markedly impact on the degree of
success in private practice. Achieving an
active practice depends on more than one's
technical skills as a physician.
Being a salaried physician provides a means of
avoiding the aforementioned risks
while at the same time realizing many benefits.
These include a secure position with
reasonably good remuneration and an attractive
benefit package that includes health
care coverage (medical and dental for both
physician and their family), paid vacations,
holidays, sick leave, and shorter, defined
working hours.
On the other hand, there are significant
disadvantages to being a salaried practitioner,
including a limit on one's income, which is
generally less than that of successful solo
practitioners (unless maintaining a limited
outside practice is allowed). In addition, there
is a loss of autonomy as a salaried
practitioner. The latter includes having to respond to
directives of the administration for whom one
works and having to satisfy one's immedi-
ate supervisor. As a result of these
liabilities, there is a marked tendency for physicians
to
undertake salaried appointments initially and,
after a few years, move on to solo or group
practices. Within six to eight years of
beginning practice, therefore, the number of
salaried physicians diminishes from well above
half to under a third. In addition, the
decline in the number of salaried employees
varies for different specialties: Naturally,
pathologists are 100% salaried with surgeons
and psychiatrists being under 50%.
Health Maintenance Organization (HMO)
Practitioners
Practitioners working for HMOs can be found in
all of the employment options dis-
cussed above, depending on the organization's
structure. Increasingly, HMOs are
becoming a major source of employment for
physicians and will undoubtedly become
even more important as the health care system
changes over the next several decades.
Three types of arrangements are
possible:
Staff Position
This is a salaried appointment under contract.
It is a very common position for a new
physician who intends, in a relatively short
period of time, to go into solo practice or
join a group. It provides an opportunity to
improve one's skills, develop self-confidence,
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