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Subject:  Re: Reflections of a Medical Ex-Practitioner Date:  4/10/2013  4:37 PM
Author:  beaconclks Number:  677305 of 888682

If they were anything like me they'd take the path of least resistance. That's the Taoist way of doing things. Whatever requires the least amount of effort for the most reward.

Work for a private practice or Physician group. Work 3 days a week and collect a big paycheck and spend the rest of the week playing and having fun.

That's pretty much how I've lived my whole life.

Art

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That's good advice. Do what makes you happy if possible.

Virtually all hospital-based physicians do work for a private physician group. Except for certain regions of the country, it's rare it find many "solo" practitioners in hospital-based practices (though there are some). Naturally, the hospital wants to negotiate and work with one group for each department (radiology, pathology, anesthesiology, radiation therapy and sometimes emergency room). The hospital has to provide these services 24/7/365 and it's much easier to insure backup coverage for sickness, vacations, etc., as well as insure adequate staffing, to deal with a representative from one group than 10, 20, or 30 different independent "solo" practitioners doing their own thing. It's especially important when something goes wrong or service is inadequate, as it makes it real easy to assign blame.

All physician groups, including hospital-based groups have a particular "culture", naturally derived from the collective personalities of the individual members. Some groups want to work very hard, run on very minimal staffing which maximizes income (to the extent possible). Other groups employ more providers (divides the group's collective income more ways), and enjoy more free time with family and friends, etc.

The most irritating and exhausting aspect of practice is usually being "on call", i.e., covering nights, weekends, and holidays. The only way to dilute the number of "on calls" to a tolerable level is to have more employed providers that "take call". Few groups appreciate employing "part-time" providers that only work a few days/wk and then only day hours, without sharing call. They'd rather hire full-time providers that share call. If the groups do hire part-time providers, since they're only working "easy hours", they are paid significantly less on a per hour basis than those providers that work the whole spectrum.

Also, the only source of income for the physician group is their fees for services provided, which are derived directly from reimbursements for services. Therefore reimbursement rates ultimately determine the income to the group, which determines how much each doctor earns. The volume of work going through the hospital each year is independent from how the physician groups are "managed". The work has to get down by someone, so if somebody is only working a few days/wk, that means the group has to hire others to work in their place when there off enjoying themselves. More employees mean more cost and lower incomes per provider. So working fewer days/wk, is incompatible with "big paychecks".

Life is funny that way.

But otherwise I agree wholeheartedly.
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