I am still a family medicine physician and still see my own patients each day. My nurse and I review all messages for the day and all phone calls are returned before we leave. (A)

Sounds great! But with the transformation of health care more and more physicians are “employed” and not in “private practice.”

The Medical Group Management Association reports that more than 50 percent of physicians are now employed by organizations affiliated with health systems. In some specialties, like cardiology, that is closer to 75 percent.

Discussion of employment tend to focus on the pros and cons for the physician.

Briefly they are:

Pros: The check will clear — The security of knowing that you are not at risk for making payroll may be significant. Both staff and physicians are virtually assured of their incomes. • Administrative headaches disappear — The hospital will worry about issues such as human resources, billing and collecting, rent and overhead, and daily operations. • Incomes are often higher — Many physicians do substantially better in an employment arrangement than they did in private practice.

Cons: You aren’t in charge — Regardless of the assurance that “nothing will change,” it does. Policies are set by the employer. Staff knows who writes their checks. You may end up seeing patients that would not have normally be part of your practice. • Compensation can be changed — Nearly all hospitals pay physicians on some form of production-based compensation formula but that does not mean that can’t change. • You may be judged by new metrics — Hospitals are aggressively adopting quality and patient satisfaction measures that are part of the overall compensation plan. • There may be new technology — Even though you have an EHR it might not be their EHR. You may need to go through another conversion. (B)

But how about the patient?

“One potential downside of the employed model is an increase in physician turnover, which can erode continuity of care. Employed physicians may not have the same financial and emotional stake in their practices as do independent physicians, making it relatively easy for them to move on as practice conditions or other opportunities dictate….

..An additional, more subjective concern is the effect of physician employment on the nature of the medical profession. Will physicians be less likely to take ownership of their patients’ health and be fully engaged patient advocates if they are financially beholden to large, corporate organizations? Will medicine cease being a calling and become in effect a trade?” (C)

“…. hospital-physician partnerships can deteriorate when expectations and accountability on both sides are not well defined up front. A physician may enter into one of these relationships expecting secure compensation and a better lifestyle with more sensible hours while the hospital aims to maintain their volume and/or build their market share with proper control. ….. paying close attention to the metrics of success for both parties, and appropriate consideration of the legal aspects of the contract, including exit clauses for both parties, is essential for long-term success.

Another potential advantage of hospital-physician partnerships is delivering a more integrated care experience for patients. “Many patients do not realize that doctors and hospitals are often separate business entities,” he said. “They assume that everyone is working together to provide them a seamless care experience. Being more closely aligned with the hospital can allow a physician to do that.”

Access to better technology and the ability to streamline care are both major advantages to a partnership,….. but “the overall goal has to be to improve quality and reduce costs of care through a more seamless integrated care experience.” (D)

If you are younger your only experience may be with employed physicians. If you are older perhaps you have already have seen changes in the physician-patient relationship from “back in the day.” So it here are some benchmarks to use:

The core elements comprising patient satisfaction include:

◾Expectations: Providing an opportunity for the patient to tell their story.

◾Communication: patient satisfaction increased when members of the healthcare team took the problem seriously, explained information clearly, and tried to understand the patient’s experience, and provided viable options.

◾Control: Patient satisfaction is improved when patients are encouraged to express their ideas, concerns and expectations.

◾Decision-making: Patient satisfaction increased when the importance of their social and mental functioning as much as their physical functioning was acknowledged.

◾Time spent: Patient satisfaction rates improved as the length of the healthcare visit increases.

◾Clinical team: Although it is clear that the patient first concern is their clinician, they also value the team for which the clinician works.

◾Referrals: Patient satisfaction increases when their healthcare team initiates referrals relieving the patient of this responsibility.

◾Continuity of care: Patient satisfaction increases when they receive continuing care from the same healthcare provider(s).

◾Dignity: As expected, patients who are treated with respect and who are invited to partner in their healthcare decisions report greater satisfaction. (E)

(A) http://www.physicianspractice.com/blog/pros-and-cons-private-practice

(B) http://www.physicianspractice.com/blog/hospital-employment-vs-private-practice-pros-and-cons

(C) http://www.aafp.org/fpm/2015/0700/p11.html

(D) http://www.healio.com/orthopedics/business-of-orthopedics/news/print/orthopedics-today/%7B18032629-f0ad-4b49-94ea-f8f69d614846%7D/private-practice-vs-salaried-employment-a-complicated-decision

(E) http://healthcarecomm.org/about-us/impact-of-communication-in-healthcare/

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