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In contrast to the traditional practice settings available to physicians in years past, today’s med school graduates have many more options. Among these are private practice, group practice and its variations, hospital employment, public health, academic medicine, locum tenens work and a health care system, such as a health maintenance organization or integrated delivery system. Each offers varying degrees of financial risk, autonomy and benefits.
For the Traditionalist
Private or solo practice is the traditional method of hanging out a shingle. The physician practices alone, which means she has more freedom and is in control of the practice. However, private practice also means making all the decisions, from providing patient care to hiring a secretary to decorating the office. To balance the independence and autonomy, a solo practitioner must take on more financial risk. She often works longer hours, as she doesn’t have partners to share emergency call or practice-management responsibilities. Some physicians join independent practitioner associations to resolve these difficulties.
Going for the Group
A group practice can help mitigate some of the disadvantages of solo practice. Group practices can be small, with three or four physicians, or very large. The doctors share the practice-management responsibilities, emergency calls and financial risk. In a single-specialty group practice, other physicians can provide expert advice for difficult medical cases. Multi-specialty group practices offer even more access to medical experts. Although group practice may increase financial security and the opportunity for additional compensation, such as a year-end bonus, individual physicians in a large practice have less autonomy.
Go Big With an HMO
Health maintenance organizations, or HMOs, employ physicians to provide care to a designated group of members or beneficiaries. Although an HMO is similar in some ways to a large group practice, physicians are employees rather than partners, and are likely to have less autonomy. HMOs commonly have specific patient care protocols that the physicians must follow. However, HMO physicians often have a more stable work life with regular hours, and they generally have fewer responsibilities in terms of paperwork or regulatory issues. In HMOs, physicians receive a salary and typically have bonus opportunities based on their productivity or patient satisfaction. A variation of the HMO is the group-model HMO, in which physicians are independent contractors rather than employees.
Integrate Your Practice
Integrated delivery systems typically include a major hospital and one or more associated clinics. The physicians are employed by the system, and often have benefits such as a guaranteed income, excellent employee benefit packages and the option to practice academic as well as clinical medicine. Hospital policies and politics can create problems for some physicians, and physicians have less autonomy than in many other practice models. For a new graduate, however, the management services and support personnel in an integrated delivery system may offset the loss of autonomy.
Other possible practice options include hospital-based practice or locum tenens work. In hospital-based work, the physician is a hospital employee with a predictable income, steady patient base and a good referral network. One disadvantage of this type of practice is the expectation that physicians will be heavily involved in hospital committee work. Mergers can also be disruptive in this type of practice. A locum tenens position offers temporary employment for a short period and may offer higher pay, according to the American College of Physicians. A locum tenens physician can often choose the work setting and geographic location, and also limit work hours if desired. However, benefits might not come with the locum tenens package, although the employer may pay for licensure and malpractice insurance.
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