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Consistency in patient and practice philosophy: an important consideration in seeking a position in private practice
THE FELLOWS’ CORNER
Consistency in patient and practice philosophy: an important consideration in seeking a position in private practice When searching for our first job, we quickly learn that there are many different ways to structure a practice. This month our guest author, Joseph Geenen, MD, explains the specifics of different practice models and how to determine which models best fit your career and personal goals. Kevin J. Peifer, MD Fellows’ Corner Associate Editor Fellow Division of Gastroenterology Washington University St. Louis, Missouri, USA Today, newly graduated GI fellows are faced with confusing and complex practice decisions: should I start my own practice; should I join an established physician; should I sign a contract with a single or multispecialty practice? As one can imagine, these decisions can generate fear and trepidation in the hearts of most GI fellows. Soon they will leave the shelter of the academic world and enter the real world of private practice. They have some vague knowledge about practice management, mostly conveyed through the structured didactic session, but little else. The decision of where to practice is one of the most important decisions of their lives. There is a greater than 50% chance that you will never move again; and, if you decide to move, it is very difficult to do. Medicine has changed. It is no longer a cottage industry but is now a big business. Bigger may not be better. The driving force in the practice of medicine is now the employer. This goes along with the golden rule, ‘‘he who has the gold makes the rules.’’ Sole practice is almost obsolete. Single-specialty groups are again becoming popular with the demise of the multispecialty groups. Other groups include groups without walls, MSOs (medical service organizations) or PHOs (physician hospital organizations and foundations). Other possibilities include being a full-time employee or joining a fully integrated group. There are several different models, including the
foundation model, the staff model, and the physician equity model. A fully integrated health system means that there is close alignment among physician, hospital, and peers. All work together as a team and abide by all the rules. Over the past 10 years, more physicians have become employed physicians, with fewer and fewer physicians entering solo practice. Also, the salary range for gastroenterologists has increased significantly during this period of time. One of the most important factors in making a decision in where to practice is the practice location. When, where, and how do you start looking? I believe that you should start
Key points d
d d
Set your goals by evaluating your 3 ‘‘Ps:’’ Personal goals Professional goals Practice goals Practice location Contract evaluation
Copyright ª 2006 by the American Society for Gastrointestinal Endoscopy 0016-5107/$32.00 doi:10.1016/j.gie.2005.10.017
looking during your second year of fellowship. You should look for ads in journals and contact hospitals, clinics, other gastroenterologists, and possibly even consider contacting a head hunter. Most of the factors affecting the decision of practice location include your hometown size, influence of your spouse, opportunities for partnership, closeness to medical school, and income potential. Before selecting a place to practice, you should set your goals. Three ‘‘Ps’’ of goal setting include the following: (1) personal goals, (2) professional goals, and (3) practice goals. Personal goals should include what income level you will be happy with; how much time you would like off each year; and what environment do you enjoy, a rural area or an urban area? When do you expect to retire, and will your retirement funding be adequate? Professional goals include what type of patients do you prefer to see, what procedures do you enjoy doing, what is an acceptable call rotation? Do you want to get involved with marketing or administration? Are these possible at the practice setting?
284 GASTROINTESTINAL ENDOSCOPY Volume 63, No. 2 : 2006
www.giejournal.org
Geenen
Consistency in patient and practice philosophy
Then there are practice goals. What is the ideal size of the group you would like to join? Which hospital or facilities are available? Is the fee structure sound? What percentage of managed care patients is present? Is there an adequate number of referring physicians? What is the practice strategy or marketing plan that you will join? In an evaluation of a practice setting, you should consider the number of physicians and the staff turnover. Do the physicians and staff get along? Have many junior physicians left? Is the computer system adequate? Is the business administrator certified? It is important to get some idea of the philosophy of the practice. Do the physicians work 40 or 60 hour weeks? Are they performing research? Are they working with physician assistants or nurse practitioners? What time is set aside for education and teaching? It is very important that you know what is expected of you at this practice. In evaluating a contract, there are 3 essentials to consider: (1) What happens if you leave? (2) What are your responsibilities and those of others in your practice? (3) How do you advance in the practice?
How does the group practice evaluate you? (1) A phone call to your teacher? The entire GI community is relatively small. (2) Are you well liked by the medical house officers? (3) Does it look like you know what you want? (4) Have you done your homework? (5) Do you come across as knowing everything that you need to know? (6) Are you a team player? (7) Do you seem most interested in money? Finally, once you have decided on a group and a place to practice, it is mandatory to have a very specific contract outlining your responsibilities, duties, when you will become a partner, and what happens if you leave. Good luck! If you consider all of these factors, I am certain that you will find a compatible practice situation.
www.giejournal.org
Volume 63, No. 2 : 2006 GASTROINTESTINAL ENDOSCOPY 285
Joseph E. Geenen, MD CEO and Founder, GI Consultants, Ltd Clinical Professor of Medicine Medical College of Wisconsin Milwaukee, Wisconsin, USA
Consistency in patient and practice philosophy: an important consideration in seeking a position in private practice When searching for our first job, we quickly learn that there are many different ways to structure a practice. This month our guest author, Joseph Geenen, MD, explains the specifics of different practice models and how to determine which models best fit your career and personal goals. Kevin J. Peifer, MD Fellows’ Corner Associate Editor Fellow Division of Gastroenterology Washington University St. Louis, Missouri, USA Today, newly graduated GI fellows are faced with confusing and complex practice decisions: should I start my own practice; should I join an established physician; should I sign a contract with a single or multispecialty practice? As one can imagine, these decisions can generate fear and trepidation in the hearts of most GI fellows. Soon they will leave the shelter of the academic world and enter the real world of private practice. They have some vague knowledge about practice management, mostly conveyed through the structured didactic session, but little else. The decision of where to practice is one of the most important decisions of their lives. There is a greater than 50% chance that you will never move again; and, if you decide to move, it is very difficult to do. Medicine has changed. It is no longer a cottage industry but is now a big business. Bigger may not be better. The driving force in the practice of medicine is now the employer. This goes along with the golden rule, ‘‘he who has the gold makes the rules.’’ Sole practice is almost obsolete. Single-specialty groups are again becoming popular with the demise of the multispecialty groups. Other groups include groups without walls, MSOs (medical service organizations) or PHOs (physician hospital organizations and foundations). Other possibilities include being a full-time employee or joining a fully integrated group. There are several different models, including the
foundation model, the staff model, and the physician equity model. A fully integrated health system means that there is close alignment among physician, hospital, and peers. All work together as a team and abide by all the rules. Over the past 10 years, more physicians have become employed physicians, with fewer and fewer physicians entering solo practice. Also, the salary range for gastroenterologists has increased significantly during this period of time. One of the most important factors in making a decision in where to practice is the practice location. When, where, and how do you start looking? I believe that you should start
Key points d
d d
Set your goals by evaluating your 3 ‘‘Ps:’’ Personal goals Professional goals Practice goals Practice location Contract evaluation
Copyright ª 2006 by the American Society for Gastrointestinal Endoscopy 0016-5107/$32.00 doi:10.1016/j.gie.2005.10.017
looking during your second year of fellowship. You should look for ads in journals and contact hospitals, clinics, other gastroenterologists, and possibly even consider contacting a head hunter. Most of the factors affecting the decision of practice location include your hometown size, influence of your spouse, opportunities for partnership, closeness to medical school, and income potential. Before selecting a place to practice, you should set your goals. Three ‘‘Ps’’ of goal setting include the following: (1) personal goals, (2) professional goals, and (3) practice goals. Personal goals should include what income level you will be happy with; how much time you would like off each year; and what environment do you enjoy, a rural area or an urban area? When do you expect to retire, and will your retirement funding be adequate? Professional goals include what type of patients do you prefer to see, what procedures do you enjoy doing, what is an acceptable call rotation? Do you want to get involved with marketing or administration? Are these possible at the practice setting?
284 GASTROINTESTINAL ENDOSCOPY Volume 63, No. 2 : 2006
www.giejournal.org
Geenen
Consistency in patient and practice philosophy
Then there are practice goals. What is the ideal size of the group you would like to join? Which hospital or facilities are available? Is the fee structure sound? What percentage of managed care patients is present? Is there an adequate number of referring physicians? What is the practice strategy or marketing plan that you will join? In an evaluation of a practice setting, you should consider the number of physicians and the staff turnover. Do the physicians and staff get along? Have many junior physicians left? Is the computer system adequate? Is the business administrator certified? It is important to get some idea of the philosophy of the practice. Do the physicians work 40 or 60 hour weeks? Are they performing research? Are they working with physician assistants or nurse practitioners? What time is set aside for education and teaching? It is very important that you know what is expected of you at this practice. In evaluating a contract, there are 3 essentials to consider: (1) What happens if you leave? (2) What are your responsibilities and those of others in your practice? (3) How do you advance in the practice?
How does the group practice evaluate you? (1) A phone call to your teacher? The entire GI community is relatively small. (2) Are you well liked by the medical house officers? (3) Does it look like you know what you want? (4) Have you done your homework? (5) Do you come across as knowing everything that you need to know? (6) Are you a team player? (7) Do you seem most interested in money? Finally, once you have decided on a group and a place to practice, it is mandatory to have a very specific contract outlining your responsibilities, duties, when you will become a partner, and what happens if you leave. Good luck! If you consider all of these factors, I am certain that you will find a compatible practice situation.
www.giejournal.org
Volume 63, No. 2 : 2006 GASTROINTESTINAL ENDOSCOPY 285
Joseph E. Geenen, MD CEO and Founder, GI Consultants, Ltd Clinical Professor of Medicine Medical College of Wisconsin Milwaukee, Wisconsin, USA