Small private practice vs. Big corporation/Big hospital system

[IMGtoPA]

New grad here, still new to the workforce, about 2 months into my first job with a small private practice (family med clinic) with 1 SP and 3 total midlevels between 2 offices.

 

Granted I am still new, but I always wondered what a job would be like in primary care setting but working for a bigger corporation that owned many clinics spanning over my local metropolitan area OR a similar job for one of the many clinics owned/operated by one of the competing giant hospital systems of my city.

 

Has anyone made a transition from small private practice to a bigger hospital system/corporate business or vice versa? If so, what are the pros/cons of each? I'm assuming benefits are much better working for the bigger company. But day-to-day operations, are they all that much different? 

[camoman1234]

I went from corporate to small private clinic. I made 30k more this year with better benefits. I work 8-10 hours less a week and much happier. I would never go back to the corporate world.

[ohiovolffemtp]

I really think there's too much site and employer specific factors to generalize.  Talk in depth with folks who work in each setting to understand their environments.

[feedme]

In general, unlike the second poster, corporations or hospitals offer better benefits (more vacation, better insurance, 401k, standard malpractice insurance, etc.).  Downside from what I've seen, they may not incentivize you as much and count on their big name to entice you in.  May have too many middle managers who can't really do anything.  May have more resources like gloves, machines, and more willingness to buy them.

 

Small practices is a gamble and you have to really research what it's like to work there from either being there and shadowing or talking to former employees (but keep in mind former employees tend to bash their former workplaces). Your happiness will likely be dependent on how well you get along with the doctor if the doctor is the owner of the practice.  You can be happy at either.  It is likely a case by case basis.

[Reality Check 2]

Been there - worked at both.

 

Current small private practice is not well run. Poor accounting. Not up to code on several state items. Being a physician (or a PA) doesn't mean you know how to run a business. The compliance issues are enough that I am looking elsewhere. Not going to risk my license for this guy. He won't listen when I tell him about things that need improvement. I am older than he is and have done this longer. So, he isn't billing correctly and we aren't making what we should and he is ignoring state regs regarding MAs, labs, etc. 

 

He also cannot get good benefits with such a small office. He is also too generous with benzos, narcs and somehow a bunch of adults have ADD and are on stimulants but haven't ever been tested..... Not my cup of tea.

 

Bright side - no one in a suit looks over my shoulder, counts beans, sends out Press Ganey or micromanages my medical which they know nothing about.

 

Corporate - seriously not my favorite. Tired of them eating up practices in towns and giving patients and employees little choice. Restricted on who you can refer to even if the BEST in a specialty works for the "other guy". Too micromanaged and controlled.

 

Too many mid level managers that my billing has to support and I cannot tell you what some of them do. Example - Regional Manager of Community Faith Outreach - Catholic medical corp. - there are several of these people - one has the job of writing up daily email blurbs to all employees of encouragement and Faith. Why does my billing support this person or several of them? 

 

Press Ganey determines your life and well being. Not remotely fair. Good medicine does not equate with a 100% happy patient. It is my job to tell people things they don't want to hear - just how it is. Nor does giving or not giving narcotics. 

 

So, neither is working well for me at this point. I would prefer that we have choices in communities and have open ability to refer to the best. If I wouldn't see a specialist or wouldn't let my family go - then why would I ever send a patient to that specialist? I would prefer that my doctor knows how to run a business or to hire people who know what they are doing with checks and balances.

 

Take everything with a grain of salt. Investigate thoroughly and ask questions until someone answers every question to your satisfaction.

 

Nothing is perfect. Weigh the options.

[mmiller3]

...

 

Corporate - seriously not my favorite. Tired of them eating up practices in towns and giving patients and employees little choice. Restricted on who you can refer to even if the BEST in a specialty works for the "other guy". Too micromanaged and controlled.

 

...

This is the only thing I would disagree with you on, at least in my experience. The private practices in the small-town area I used to work all willingly sold to the local hospitals, and every one of them was happier for it. They made more money and had far less headaches. It may restrict patients on which hospital the provider they choose to see is affiliated with, but the private-practice patients all followed their PCPs. Most of them didn't even know things had changed. I work for a larger, corporate hospital system now, and the only restrictions I have on referrals are insurance-dictated, not hospital-dictated.

[Reality Check 2]

This is the only thing I would disagree with you on, at least in my experience. The private practices in the small-town area I used to work all willingly sold to the local hospitals, and every one of them was happier for it. They made more money and had far less headaches. It may restrict patients on which hospital the provider they choose to see is affiliated with, but the private-practice patients all followed their PCPs. Most of them didn't even know things had changed. I work for a larger, corporate hospital system now, and the only restrictions I have on referrals are insurance-dictated, not hospital-dictated.

You are lucky. That does NOT happen where I am. Corporate dictates EVERYTHING. Your schedule. How much time per patient. How many patients per day. They critique everything. One sent a team of suits with a stop watch and timed the provider in the room. Seriously - overkill and so insulting.

 

I got called down for sending a patient to a non-corporate outside ortho because the patient wanted it. I still got in trouble for not forcing the patient to see someone they didn't want to see and I wouldn't see personally.

 

The biggest cardiology service in town is currently suing the corporate to undo their purchase. They hate it. They want to be independent again.

Many private little practices in town that were bought have seen the doc bail - move out of town - leave - one went back to Canada.

 

The patients have noticed everything! They don't like the website. They don't like the forms. They call it impersonal and rude. 

 

So, glad you had a good experience but it is certainly not working where I live - county of about half a million. 

 

It is awful and is contributing to the downfall of the ART of medicine.

[mmiller3]

That sounds terrible. What state do you practice in? Also, weren't you interviewing for a different position?

[Reality Check 2]

Washington.

 

Prior corporate experience that I left. Pay scale was nice, bennies decent but atmosphere oppressive, not provider centric nor patient centric. All about the numbers..... and convincing the community that nonprofit faith based meant kind and benevolent while constantly warring with the "other group" in town who is for profit and openly evil.

 

The two control 85% of employment in town which severely hinders medical professionals.

 

Waiting on return from recent interview. Turned one down - another small private ancient that just made the hair on my neck tickle enough to warn me off - too much risk with minimal bennies.

 

My options are limited and moving not realistic. I either lower my standards (not sounding attractive) or get out of medicine. Have to support my family. Kinda trapped.

 

Not a sunshine and unicorns kind of day right now... working on attitude.... and eating a cookie, dammit

[mmiller3]

Good luck in whatever you choose, RC2.

[UpRegulated]

Will echo some of what's been said.  Worked for a private physician owned group.  Now work for a larger, more corporate "system."  Like anything else, it just depends.  Physician-owned sounds great until you realize there are too many chiefs only interested in their personal bottom line which paralyzes the group and keeps it from getting anything done (such as compliance) and keeps it from operating efficiently.  The group CEO was basically a figure head, as the partners called all the shots, yet none of them agreed on anything.  The net result was perpetual infighting and sub-standard non-compliant mediocrity at best.  

 

I now work for a non-profit "system," which has solved the above complaints.  They are all about compliance, yet give the providers the freedom to be providers, and seem to treat the providers as such.  I have zero complaints so far.  The non-profit status helps tremendously, as they don't seem to be so obsessed over profit margins, and seem to make decisions more from the perspective of service to the community over profit margins.  Having said that, every person/group/organization has to at least cover their costs or the doors will get shut, and every place has politics, and the decision makers aren't patient-facing in larger organizations (though patient-facing didn't seem to make a difference in the private group I was in either - they only seemed to care about how fat their personal wallet was).

 

These things are human nature and mostly inherent to any organization, health-related or otherwise. I've only been at my new place a short time, so time will tell.  I'm a career changer and worked for years in the corporate business world prior to becoming an NP.  One thing I've learned well is the old, well-known adage: the grass always seems greener on the other side.  Switching from one organizational model, or one organization, to another often amounts to just exchanging one set of problems for a new set of problems. Some organizations really are better than others, though it's hard to tell just by going through interviews and researching.  You'll never really know until your there and have been there for a while.