September-October 2004, Volume 1, Issue 5
The Private Practice of Hematology
Published on: October 01, 2004
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.
Multispecialty 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 multispecialty groups.
Corporate employers, whether single or multispecialty, 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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