Your Degree of Business Involvement

You will encounter business and economic decisions regardless of the type of practice that you choose. The only question is the degree of your financial involvement, which will vary based on your practice type.

For example, physicians who start their own solo practice face many financial hurdles such as insurance, tax, and licensing issues, as outlined in a previous blog. Medical Economics magazine is a helpful resource that can help you plan and prepare to start your own practice. You can also check out The American Academy of Family Physicians website, which provides a detailed 13 point outline.

Generally, if you join a solo or small group practice, most of the business aspects will already be established. A large group or multispecialty group practice is likely to present a new physician with even fewer business decisions because many of these practices have a formal governance structure. Dr. Shaw’s book mentions that even if your practice has a formal governance structure in place, there may be opportunities to be active in the governance of the group if you want business involvement.

You should only use the aforementioned information as a guideline because each individual practice is unique. Some large group practices require more business involvement of their physicians than an average small group practice.
Some physicians truly enjoy the business aspects of their practice while others see finances as an obstacle that interferes with their work. During the job selection process, consider the degree of business involvement that you want to undertake and choose your future practice accordingly.

Part III: General Practice Type Considerations

Before we wrap up this blogs series on practice types, there are several issues to consider regardless of the type of practice you decide to join.

First, always do you homework and observe how other physicians and administrative staff actually run the practice before you make a commitment. Beware of facades that might not convey the true nature of a practice. Additionally, remember to take into account the employer’s perspective as a recruiter.

Second, it is important to fully understand your actual compensation structure. It might help to review our blog on signing a physician employment contract.

Finally, bear in mind any miscellaneous economic advantages of a specialty. For example, if you work in a practice with several other physicians, in some cases disability insurance policies can be discounted by up to 50 percent when three or more physicians from the same employer buy a policy. Over the life of a policy, that can amount to substantial savings. In addition, physicians in a single specialty large group or multispecialty large group practice can take advantage of low cost group disability plans for 10 to 499 employees.

Disability insurance group discounts are only one example of an economic benefit that is available to physician in certain practice types. The last few blogs have offered a series of factors to consider when choosing a practice type. Evaluate those factors holistically and align them with your personal preferences in order to determine your ideal practice type.

Part II: Single Specialty Groups, Multispecialty Groups, and Alternate Paths

A single specialty small group practice is a great environment for a physician who wants to start in an established office and be busy with patients immediately. Before you join a single specialty small group practice, consider Dr. Shaw’s advice: most practices should keep their professional expenses below 50 percent of gross.

Many physicians are enticed by the cost advantage of a single specialty large group practice. Physicians can share business overhead expenses and may also enjoy working with and around a large group of similar physicians. As practice size increases, however, administrative staff and management size can become unwieldy and cumbersome.

Perhaps the greatest benefit of a multispecialty group practice is that physicians benefit from a built in referral base. Many physicians in multispecialty group practices also enjoy fewer working hours. In general, compensation in these practices may not be as competitive. Check back for our upcoming blog on negotiating a physician employment contract if you think you want to join a multispecialty practice group.

Finally, there are career paths such as locum tenens, academic practice, and military service. Locum tenens is an alternative to permanent full-time practice that has gained popularity in recent years. Academic practice allows physicians to interact with students and residents although tenure is not easy to achieve and salary is generally not as competitive as the private sector. The New England Journal of Medicine profiles military physician career information and provides links to other informative resources.

Practice Types Part I: Starting or Joining a Solo Practice

After you determine your ideal location, the next basic step is to decide the type of practice in which you want to work. Although the different types of practices are too numerous to analyze within the context of this blog, we can highlight the pros and cons of several of the most popular practices types for physicians. If you want even more detail, look to chapter 3 of Dr. Shaw’s book.

Part I of this blog series will contrast starting a solo practice with joining a solo practice. Part II will investigate single specialty group practices, multispecialty group practices, and other alternative career paths. Part III will advise you of considerations regardless of the type of practice that you want to join.

Starting a solo practice is demanding and places a great burden of responsibility upon a physician, but can also be very rewarding. Physicians who start their own practice enjoy flexibility and autonomy. However, you must have the patience to build your patient base. Start up costs and initially inconsistent revenue are not always the best match for a resident with high medical school debt. Our upcoming blog on business involvement in your practice will offer advice about how to start your own practice.

Join an existing solo practice if you want to work in a smaller practice but are willing to sacrifice some occupational autonomy in exchange for an existing patient base. Be sure to perform your due diligence regarding the solo practice and make sure that you have good chemistry with the other physician in the practice.

Determining Where You Will Practice

The first step in the job selection process is to create a self-evaluative profile so that you can determine your preferred location. According to Dr. Shaw, new physicians only stay at their first job for about three years. Relocation is expensive in terms of reestablishing personal and professional relationships and rebuilding your patient base. If you take the time now to choose your ideal location, you can avoid a costly mistake later on down the road. The following factors are all significant:

City/Town Statistics
· Cost of Living
· Various City Rankings (or This Site)
· Crime Rates
· Climate
· Quality of Schools

Marital and Family Status – These factors are relatively self-explanatory, but I mention them because for many physicians they are the most important consideration. Keep in mind that if your spouse is also a physician, you need to find an area that can support each of your specialties.

Your Specialty – Be aware of how the demographics of a location will affect your practice. For example, if you are a pediatrician or your specialty is geriatrics, the U.S. Census Bureau is a great resource to analyze age data by geography.

Also note that in addition to a higher cost of living, salaries in large cities generally tend to be lower than they are in rural and less populated areas where there is less competition. There are, however, many exceptions to this rule. We will cover salaries and benefits (disability insurance, of course) in more detail later in this blog series.

Guiding You Through the Job Selection Process

While you focus on your residency, a complex job selection process looms ahead. That process includes many important business and economic decisions. Most experts recommend that you begin your job search one full year before you finish your residency. If you are about to enter your final year of residency, you should start your job search now so that you are on a realistic pace to complete your search by the time you graduate. Over the next several months, our blog will offer you job selection tips in an effort to decrease any stress that you might be feeling about the process.

Dr. Koushik K. Shaw recently wrote an excellent book, The Ultimate Guide to Finding the Right Job After Residency. We will highlight some of Dr. Shaw’s recommendations and supplement his suggestions with additional advice and links to relevant websites. Many of the topics will be business-related, including salary and benefits negotiation; the job type that best fits you; performing due diligence in investigating a practice; and investing in disability insurance now to save you money later. However, we will also examine topics such as the interview process and potential pitfalls; the credentialing process; and your curriculum vitae or résumé.

What You Need to Know About 24-Month Benefit Limitations

Some disabilities are diagnosed based on limited or objective medical evidence, regardless of whether they are physical or psychiatric in nature. For example, with lupus, a physical autoimmune disease, diagnoses can be elusive and symptoms vary greatly. While there are established criteria for diagnosing lupus, many patients may have it while still not meeting the full criteria. Clinical depression, bipolar disorder, anxiety disorders, and post-traumatic stress disorder, which can all be complex and/or nebulous when it comes to diagnosis, are examples of psychiatric disorders.

Because the diagnosis of some disabilities is based on limited or objective medical evidence, many insurance companies limit benefits for these types of claims to 24 months. This means that a policyholder diagnosed with depression would receive benefits for a maximum of two years.

While it varies by state, many insurance companies already have a 24-month benefit limitation or are moving towards one. Be sure to review a policy’s coverage of psychiatric disabilities before purchasing it or ask an expert. Contact Doctor Disability at 866-899-7318 to get personalized information regarding available options.