The Independent Spirit
Despite many physicians making the move, there are some, like Hollister, holding onto their independence as long as they can. Daniel Hoffman, MD, a primary-care physician in Dunlap, Ill., says he is "too damn independent" to ever sell his practice. He sees plenty of advantages to being an independent physician, including some simple things.
"My waiting room right now is decorated for Halloween. There are mannequins of Pinhead from Hellraiser, Freddie Kruger, Michael Myers, the guy from Scream, Frankenstein, Chucky, and Hannibal Lecter. Full-sized mannequins in the waiting room. If I tried that [in an employed practice], the hospital would fire me on the spot," Hoffman says. "I can do it here and people can bring their kids to check out the mannequins and have fun."
This independent spirit, mentioned also by Hollister, is why Hoffman is the last guy in town to have not sold his practice to an employer. He says economically, being a practice owner gives him a sense of entrepreneurship that he'd never get as a hospital employee. He is a business owner with control over his medication and equipment supply. He can also receive numerous tax deductions to help himself financially, an opportunity not afforded employed physicians.
Linda Girgis, MD, an independent family medicine physician in South River, N.J., is another independent spirit who likes the control her private practice allows. She says it allows her to try new services and find new ways to make more money, such as cosmetic procedures. Furthermore she says, "You can make changes in your practice without having to go through different approval stages. I want to pick a new EHR, I can do that. If you're employed, you don't get much say over that."
Marni Jameson from the Association of Independent Doctors says that in an independent practice, doctors get to call their own shots when they run their own business. On the flip side, she says, because of having to fill quotas and complying with the hospital's rules and regulations, physicians' allegiance changes from the patient to their hospital employer when they become employed.
"It's insidious and they don't mean for it to happen, but it does,” she says. “When they have a hospital administrator looking over their shoulder, their head is inadvertently turned [from the patient] and they're thinking about their employer."
From a compensation standpoint, Jameson and Hollister both warn physicians that the employment contract is often front-loaded in the first year, with big carrots offered to incentivize physicians to sign. Beyond that "honeymoon year," as Hollister calls it, the contracts often include provisions which make it difficult for the physician to provide clinical care freely. They also include non-compete clauses which make it hard for physicians to practice medicine in their area if they ever leave that hospital.