Differentiating Among Practice Settings

Upon completion of a residency or fellowship program you have many practice options available to you. Sometimes it is a good idea to explore as many of them as you can in order to get a feel for what setting you actually prefer.

Staff-Model HMO’s

While this would have been frowned on even just a decade ago, staff-model HMO’s may be the best option for a young physician in this economy. They offer a fairly consistent and standard pay package and physicians are employees of the HMO. They also introduce the younger physician to many varied aspects of patient care and valuable on-the-job training. Support from fellow team members and financial solidity make the HMO a desirable practice in this tough economic climate. Hours also tend to be more reasonable in an HMO than in different practice settings, making it a great lifestyle choice for those who want a good, work-life balance.

Non Staff-Model HMO’s

There are a variety of HMO’s that do not employ physicians directly and instead treat them as contractors. These are the Group and Network model HMO’s. They offer the traditional benefits of working at an HMO with the freedom of working as an outside contractor. The less experienced physician may want to begin at a staff-model HMO and work up to this kind of system if they enjoy the HMO practice setting.

Integrated Delivery Systems (IDS)

An integrated delivery system usually involves a community hospital system where the physicians are IDS employees. While employment at a hospital can lead to politics and the occasional human resources issue, the academic and team support is usually second to none in the IDS model. Salary is usually a bit higher here than an HMO. The hours that one is expected to work, especially when new, are also increased over the HMO model. The management and support personnel available at such an organization can be a great resource for a newer doctor.

Hospital-Based Practice

Here physicians are typically employees of the hospital itself. Team support and being “close to the action” are both big wins for this kind of practice. Again, hours and salary are both a bit on the higher side with this practice model. Committee work is frequently expected and this can cut into patient hours. Inquire about any extra duties up front so that you know what you are getting into.

Locum Tenens

A physician working in this manner is typically attached to an employment agency. While this may sound a bit daunting to many physicians, it gives the newer physician an opportunity to try out different practice models and employment settings without the risk of having to quit if they do not like the position. Commitments are usually short, from a few weeks to a few months at a time and the agency typically picks up any malpractice insurance for you.

Group Practice

A group practice is a great idea for those who want the freedom of a private practice without the risk. Capital costs are usually shared between doctors as well as support staff. While the rewards of such a practice are high, this option does not provide the broad range of experience the above models do. It does, however, offer a practicing setting that allows you to build close relationships with your fellow physicians and ask questions and use them as mentors in your early years. With this option, you have the ability to learn, first hand, all aspects of running your own practice.

Private Practice

There are a couple of large cons to opening a solo practice right out of residency. The biggest one is obviously the financial risk in such harsh economic times. Private practices tend to be the refuge of the established doctor who is looking to settle down in a quiet, rural community rather than the choice of a newer physician who may lack the necessary financial support or real-life experience. With the right support, however, and meticulous management practices, the financial rewards can outweigh the risk. A physician who knows how to keep overhead costs down will do well in this type of setting. One must operate well on their own and be pro-active with peer-interaction in the community to gain referrals. While you are the best judge, this is not a common choice for a new physician just starting out in practice.

What do you think? Please share your opinion and let us know how you found the right practice setting for your career.

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