Over the past 5 years, there has been a major shift in physician practice models, with fewer doctors working in the small, physician-run practices that were considered standard in years past.
More and more physicians are becoming part of large hospital systems than ever before. Often, being part of a large hospital system means working as an employed physician, which has some fundamental advantages and some inherent disadvantages. Doctors who are employed by large hospital systems do not have the same degree of independence as self-employed physicians, which can be a tough concept for physicians who do not want to have to answer to a ‘boss.’ However, while affiliation with a hospital system is becoming the trend for many doctors, full-time employment or disheartening lack of profession independence is not the only option.
Further reading: Hospital ownership of physician practices on the rise
In fact, the reality of physician employment arrangement can involve a grey area that combines working for or within a large hospital system with varying degrees of independence. And there are almost limitless options in terms of what constitutes independence.
Setting Clear Boundaries
Eric Tait, MD, MBA, is a primary care doctor in Houston, Texas, who went into his employment negotiation with IASIS Healthcare in Houston with the objective of working as an employed physician while also maintaining his previously built outside business contracts as well. He says that the key to his own negotiation process was rooted in his understanding that “primary care physicians are valuable to a healthcare system” and that his worth to his employer as a primary care physician gave him valuable leverage.
Prior to joining IASIS, he had already built an investment partnership in an independent practice association, which is a partnership between physicians and insurers. When he agreed to a contract that allowed IASIS, his employer, to collect revenue from his clinical work and pay him a salary, he made it clear upfront that he would not share any of his IPA partnership rights with his employer.
While this arrangement certainly sounds fair to most physicians, the reality is that many doctors have been dragged into (and lost) legal battles with employers who have claimed legal rights on physician revenue from outside business ventures, ranging from expert medical witness testimony to ownership in diagnostic facilities. Tait advises physicians to “insist upfront on establishing walls between outside work and the reach of employers.” This advice is quite different from the trap that many physicians fall into- which is ignoring or even hiding business arrangements, and then running into problems with employers after outside work is discovered. Tait also urges physicians to recognize that even as employed providers, they still have rights to own businesses in healthcare.