Hospital practice can come with pitfalls for doctors

I read recent New York Times and KevinMD.com items about the migration of doctors to hospital-owned practices. The benefits are obvious: guaranteed salary, regular hours, malpractice coverage, paid benefits, school loan repayment.

I worked for a hospital system in a small suburban practice in a large Midwestern city for almost four years. I did indeed enjoy the subsidized salary. Who can argue with vesting? I had a terrific group of administrative resources who didn’t cost me a cent. I was part of a large team of primary care physicians who felt valued, cared for, insulated from the pain of negotiating directly with insurers.

There were the odd moments, however.

Once, my administrator announced that I was in breach of contract if I ever referred a patient to a system outside mine. “But don’t worry, he said, I wouldn’t dream of suing you … Unless your ancillaries dropped below the mean.”

Still, I loved my corner of the world. My quality surveys were good; my new staff terrific. I had a nice, ever growing group of patients. Most of all, I heard over and over from the hospital: “The practice is great! We can’t wait to expand.”

But then, one morning a few months after the latest “It’s great!” meeting, the administrator asked if he could drop by. In a ten minute stop, en route to “hire some cardiologists” he announced that my practice was closing.

“We’re realigning, and it’s going to be great! Don’t worry!” he reassured me, “We will find a new place for you, and you will love it.”

Not so much. A month went by before I heard from the hospital again. By then I was frantically looking for work and new homes for thousands of patients. I went to see one other practice. The physicians were great, but it was located far from my existing practice. Many of my patients wouldn’t follow me, and your work is based on production, if you lose 50% of your patients, you lose 50% of your income.

The end was fast and painful. Patients had less than a month’s official notice from the hospital that I was closing; their letter made it sound as though it was my choice. Patients were frantic, halfway through cancer work-ups, surgeries, nursing home admissions. I cried with dear people I’d known for years. My staff and I endured, barely.

All is fair in love and war. I landed on my feet. Caveat emptor to those considering employment, not privately-owned practice. To the hospital recruiter you are a bonus. To a hospital accountant you are a cost center, not a caring provider. Your patients — not you — are potential revenue.

Enter agreements with your eyes wide open and keep your curriculum vitae up-to-date.

Victoria Rentel is a family physician.

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