Career Planning
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Finding the Right Practice
Considering Hospital Employment
As the name suggests, physicians seeking this type of position have an employment agreement and contract with the hospital, and are therefore “hospital employees.”
The hospital typically manages many of the administrative aspects of the practice such as billing, insurance contracting, and human resources.
As the name suggests, physicians seeking this type of position have an employment agreement and contract with the hospital, and are therefore “hospital employees.”
The hospital typically manages many of the administrative aspects of the practice such as billing, insurance contracting, and human resources.
There has been a trend towards more hospital employment opportunities with private practice on the decline in general.
KEY ATTRIBUTES
There are several considerations when determining if an employed position is an appropriate choice for your career.
Clinical-Only Opportunity
Physicians employed by hospitals can opt to have a purely clinical work schedule. Their focus is on patient care with minimal tedium from additional duties or roles. They see patients when scheduled and are truly “off” when not scheduled.
For some this may be a very attractive aspect of hospital employment: do the job you were trained for, and let ancillary duties be managed by others. If you know this is what you want, then you can specifically seek practices that support this model.
Structured and/or Flexible Hours
With hospital employment you may or may not have flexibilty in picking and choosing your actual schedule. Depending on the size of the group, the number of facilities covered, and the internal practice dynamics, you may have quite a bit of autonomy in how you want to structure your schedule and the amount of hours or weeks you want to work.
Shared Governance
In order to attract talent, hospitals that employ physicians typically attempt to create a shared governance model to ensure physicians have a seat at the table when it comes to decisions, policies, and changes impacting patient care.
It is important to understand the degree to which physician independence may be diminished with employed positions. Decisions can and will be made largely outside of your control.
Smart hospital administrators recognize, however, that engaged physicians are truly at the heart of the hospital’s mission, and in most financial models, remain the key revenue generators. Getting involved is critical to help shape decisions. The old adage is certainly true here: “If you’re not at the table, you’re on the menu.”
Physician leadership is an important factor with hospital employment. Be sure to consider this when thinking about an employed career path.
More and more programs offer support for formal leadership and business training, which can be attractive to those who wish to continue to broaden their skill set.
Committees
This is not uncommon to the academic institutions you are familiar with now. Non-academic hospitals are also heavily dependent on committee structures.
As a hospital employee you will encounter these governing and decision making bodies frequently either because you are asked (or “volun-told”) to participate. Or you may truly seek these positions out due to the potential for impacts on you or your patients.
Committee-run hospitals can be taxing on physicians because there can be layers of bureaucracy, a lack of authority to make and execute decisions, and a markedly different perspective of timeliness versus the decision making that occurs at the bedside.
Engaging in the process may be a way to offset the perceived lack of control. With hospital employment there will be endless opportunities for you get involved. Just be sure to recognize the difference in mindsets that occur between different disciplines.
Teaching and Research
We all know the tremendous contribution that academic programs make to the development of our future healthcare providers, and to the cutting-edge research that leads to revolutionary changes in medicine. Some may not be aware that non-university affiliated health systems and community hospitals without medical schools do often still have fellows, residents, and medical students. Many provide rotations for a wide variety of clinical students.
If teaching is an interest, but some other aspects of academic medicine are not, you might want to consider such an opportunity. A number of these institutions also participate in research and clinical trials, so be sure to inquire if that is a priority for you.
Salary and Benefits
For most hospital employment positions, you can expect a predictable income with some or all of your income as a paid salary. Along with a typical salaried compensation model, you will likely enjoy a number of valuable employee benefits. Performance incentives in varying forms are also becoming more common.
This is typical of academic positions also. However, some strictly private practice settings may focus more on salary compensation, leaving retirement, healthcare, and malpractice benefit determinations up to the individual physician. If participating in a more structured plan is important to you, hospital employment can have attractive benefits packages.
PRACTICE CHALLENGES
having less influence in decision-making
potentially more limited income potential than private practice
complying with hospital policies
less flexibility over schedule
less autonomy
having hospital administrators as your “boss”
less control over compensation
may have a significant amount of bureaucracy
PROS
steady income with benefits, in larger groups there is more stable call coverage and a more predictable work schedule, less business or legal risk, built-in referral network, professional comradery, subspecialty support, administrative and management support
CONS
diminished autonomy, committee work, less control over decisions, hospital policies and procedures, hospital decisions could impact your practice, possible productivity demands or performance metrics to maintain salary, less flexibility in schedule
- Do you desire financial security and less business risk?
- Do you prefer the freedom of not running your own practice?
- Do you prefer to do clinical work only?
- Would you like a better chance for a healthy work-life balance?
- Do you want less administrative burden?
- Do you want an attractive benefits package?
- Do you prefer to focus solely on patient care?
Additional Resources
An overview on the top issues faced by physicians employed by hospitals and suggestions on how physician leadership can help.
An in depth review of the challenges physicians face with hospital employment positions.
