Who Should Physicians Work For?

January 25, 2018

Would you rather work for an independent practice group, or are you better off employed by a health system?

Would you rather work for an independent practice group, or are you better off employed by a health system (hospital, facility chain or corporation providing physician services)? This is a key question that, as a physician, you should ask yourself regularly to develop a career that meets your professional goals. Doing so now will help point you toward the employment model that's right for you, the facilities where you work, and the patients you serve.

Both employment models have advantages and drawbacks, and either model can offer a route to a successful career. Keep in mind, however, that independent groups are gradually losing market share as health systems integrate services both vertically and horizontally, limiting employment options for physicians seeking an independent practice environment.

On the other hand, as health systems broaden their strategies, their need for physicians continues to grow in new directions. Physician workforce demand is burgeoning in areas such as ASCs, urgent care centers, telemedicine, and insurance as these fields align and integrate with more traditional outpatient offices, hospitals, and SNFs. These opportunities benefit both independent as well as employed physician groups.

If working for an independent practice group:  

1. Constantly and critically evaluate your group's performance. This information may be difficult to obtain, and its easy to convince yourself that all is well. Absent regular and transparent feedback you really don't know how you or your practice is viewed by your clients, and you don't want to wait until the next contract renewal discussion to find out.

2. Participate in the selection and the onboarding of new practice colleagues. Increasingly, the way you're perceived is increasingly tied to perceptions of your practice colleagues in the eyes of the medical and administrative staff. You cannot align with your clients until you first align with your own practice colleagues, so you want to be part of the process.

3. Keep an eye on important financials. Become familiar as best you can with the financial condition of your group. If you are not a practice partner then getting a look at the P&L may be difficult, but it's still a good idea to ask. At least you can ask for a redacted view showing all but the bottom line and individual compensation. It's fair to seek assurance that your practice is growing or at least stable with solid encounter volume and a well-supported back-office operation.

4. Stay abreast of growth prospects. Find out who in your group is responsible for marketing and business development activities such as pitching new prospective clients, making your presence known in your community by adding market share, and expanding service capabilities  internally. What progress is being made toward practice growth through these efforts? A practice standing still is a practice that's likely to weaken over time.  

5. Assess the quality of your leadership. It is essential that you have confidence in the leadership of your practice. This confidence must be earned by developing mutual respect over time through shared experiences both big and small. If this doesn't happen then you have little chance of optimizing your career satisfaction as a physician, and you'll want to act accordingly.

 If employed by a health system or corporate entity:

1. Know how your employer is viewed by other non-affiliated physicians in the community. Is your employer getting a fair share of community referrals from them? If your system is not a referral of choice, for your specialty or for other specialties, it is important to know where you stand; you may be affected in ways that are not always obvious.

2. Understand the culture of your employer and how well you fit into it. Company cultures are difficult to change in any organization and won't change quickly regardless of the effort. That said, corporate cultures come in many shapes and sizes, and there may well be one out there that's right for you. If your culture does not meet your expectations then find a different one.

3. Know your employers' capabilities. As in any industry, health systems vary in the quality of their management, financial health and prospects. Know your employer's capabilities on these matters and what they're planning to do to shore up any weaknesses.

4. Gain familiarity with the other physician practice groups in your specialty that share your employer. Depending on the circumstances they may be working side-by-side with you or at other care sites. While you always want to display teamwork and professionalism, be aware that you may be viewed as a competitor, or as an opportunity to gain market share at your expense.

5. Make sure that you and your physician colleagues act and feel as if they are well aligned with your employers' goals. There is solid evidence that health systems benefit greatly from having physicians in the C-suite. This should provide some reassurance that the corporate administrators are actively supporting your primary objective of providing quality care to your patients.

During their career, many physicians will practice in both work environments. In the end, it is a matter of personal preference and opportunity, and both employment models offer opportunities for success and career satisfaction. What matters most is that you have confidence in the overall health and quality of your practice group and the organization you work for. That's far more important than whose signature and title is at the bottom of your paycheck.

Todd Kislak is managing director of Kislak Healthcare Associates LLC, a healthcare consulting firm based in Los Angeles. He can be reached at todd@kislakhealth.com