A March 21 Association of American Medical Colleges (AAMC) report found the U.S. is expected to face a physician shortage of between 13,500 and 86,000 by the year 2036. Researchers say the continued need for more physicians is related to population growth and aging.
With this information you can feel more confident when negotiating an employment contract or seeking funding or income guarantees, and not just take the first offer that comes along. It also signals how in-demand your services will be and considerations for how that will pan out in various practice settings.
The first step: Determine what you want and what you need. If you are new to practice or considering a relocation, here are some considerations:
- What kind of practice do you want? Solo, small group, large group, employed, academic?
- Where do you want to live?
- What family ties are involved? Will you need family in the area?
- What about your spouse’s career?
- Is loan repayment an issue?
- Can you afford to live where you want to live? Do you have a lot of debt? Is the cost of living too high?
- Have you considered your hobbies and other interests? Do you like to ski, paddleboard, boat, run, etc.?
Here are some pros and cons that may come with various physician-owned practice settings:
Solo Practice
Positives
Total independence
Decision-making authority
Clinical autonomy
Practice design
Control of future
Immediate rewards
Negatives
Business administration responsibility
Sole risk assumption
Fiscal responsibility
Less insulated from economic and fiscal impacts
Considerations in solo practice:
- Is your personal credit history established, stable, and in good-standing if you need to acquire a loan for start-up and working capital?
- Who will help cover call?
- Is there a need for your specialty in the area?
Small Group Practice
Positives
Like-minded
Few competing interests
Active role in governance
Shared risk and overhead
Access to colleagues for case consults
Negatives
Affected by colleagues’ performance
Less independence
Shared financial losses
Fewer predictable referrals
Less capital and patient volume for purchases
Large Group Practice
Positives
Overhead costs and financial
risk shared among more
physicians
Referral opportunities
Clinical synergy
More leverage in negotiations
Negatives
Greatly reduced independence
Compromise
Hierarchy
Liability for group financial and clinical performance
Considerations in small or large groups:
- Are there opportunities for ownership or buy-in?
- What does call coverage look like?
- How are new patients assigned?
- Do you share staff, or do you have dedicated help such as a medical assistant, scribe, or advanced practice providers?
- Is the practice considering a sale or merger in the near future?
- Is the practice in good financial health?
Asking questions and doing due diligence will prove worthwhile and help to avoid a costly mistake. Have a support or advisory team, which could consist of a practice management consultant, an attorney who is board certified in health care, an accountant, realtor, banker, credentialing partner, and recruiter.
Talking with colleagues who are already in a practice environment to which you aspire is critical, as is networking with mentors and experienced physicians who know colleagues in such settings.
It’s your practice – be involved in the entire process.
Need More Help? Try These Tools:
- American College of Physicians: Practice Settings Information
- TMA Webpage: Practice Help
- TMA Education: Non-Competes and Restrictive Covenants
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