Daniel Rosenblum, M.D.
2004-10-01
Dr. Rosenblum is a past Chair of the ASH Committee on Practice and was in private practice for 26 years.
What are the options for careers in private practice? Which will
work best for you? Use of the kinds of analytic skills honed in your
training as a hematologist may help you find answers.
The spectrum of opportunities for practicing hematology and the
communities in which to practice is very broad. Hematologists are
unevenly distributed in our country. Some communities are saturated
with hematologists; others are underserved. The spectrum of familiarity
with hematologic evaluation and treatment in the general medical
community also varies widely. Therefore, the professional activities of
hematology consultants differ dramatically in different regions.
Solo hematology practices are vanishing. The economic risk required
to sustain a solos practice is often excessive. In large urban areas,
groups are the rule. The need for hematologists is insufficient to
sustain a solo practice in an area with a population less than 100,000.
The accompanying table shows a comparative analysis of the
characteristics of various types of practice. Small groups promise
individual independence, but often provide little buffer against
inadequate management skills. Members of small groups are vulnerable to
risks such as personal and family illness, pregnancy, disputes, runaway
overhead, and bad debts. Few small groups survive intact for decades.
Larger groups usually have more organization, written agreements,
tighter controls, and arrangements for conflict resolution and are
likely to suffer if they don't. Members exchange independence for
improved risk management and reduced vulnerability to unforeseen
events. Single specialty groups are likely to push new members to build
personal consultative services or to assume the load of a senior
partner at discounted fees. The terms of the contract are critical to
your career development. It is reasonable to accept such an arrangement
for a few years provided you have a written agreement that specifies
the conditions for full partnership. Without such a contract, another
fresh trainee could replace you after you have devoted several years to
the practice.
Multi-specialty groups may be hungry for help. They have many of the
organizational attributes of single specialty groups, but control can
be a major issue, particularly if a procedure- or hospital-oriented
specialty dominates the group. If you are asked to replace a busy
physician who plans to retire or is suddenly unable to practice,
established referral patterns may keep you busy. If the group plans new
ventures, you should check the details for risks, particularly if the
plans are contingent upon your cooperation. Determine how the revenue
stream is divided and conflicts are resolved. Written agreements are
essential to maintain effective parity in multi-specialty groups.
Corporate employers, whether single or multi-specialty, provide the
firmest support for the new member. Professional management, formal
contracts, and established policies are the rule. Corporations provide
benefits, vacations, sick leave, and retirement plans. They purchase
equipment and control overhead. If the corporation is well-capitalized,
your salary may be protected against revenue shortfalls. You should
understand the performance standards and the consequences if you fail
to achieve them. Freedom is often limited, patients are assigned, and
conflict resolution is apt to favor management. Corporations can fail,
however, and your income may ultimately be linked to corporate
earnings.
Before committing yourself to a contract, you should check the
group's sources of revenue, experience with payers, credit rating,
outstanding loans, history of lawsuits, experiences of physicians who
have left the group, and staff relationships. Under favorable
conditions, private practice is an ideal venue for the personal
expression and creative talents of an energetic hematologist, limited
only by human imagination.
This article was written in a personal capacity and does not represent the opinion of the FDA, DHHS, or the Federal Government.
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