Hospital vs Private Practice: Which is Better for Cardiologists?

I have been working as a cardiologist for almost 25 years – both in the hospital as an employed physician and in the private practice world. I have truly valued the time I spent in each setting, and I feel very fortunate to have been given the opportunity to experience both. There are definite similarities, such as the patients, procedures, number of hours worked, and the technology used. However, there are also many differences one must keep in mind when choosing which path to take.

Hospitals Have Their Advantages

Depending on which physician you ask, you will get a different response to the question, “What is the best thing about working for a hospital?” Make no mistake, being employed by a big healthcare organization has its advantages. In my opinion, the major benefit to the physicians is the current payment model and not directly having to deal with the headache of a budget and overhead. I, on the other hand, thought this approach would be excellent for doctors to better coordinate healthcare. In this circumstance, it means providing cardiac care, controlling costs and practicing evidence-based, state of the art cardiology as a team. The primary focus is creating a trusted, true partnership between physicians and hospital administration. This would lead to major improvement in value-based medicine for the patients. The major components of this partnership are trust, commitment on both sides and transparency. If any of these components fail, the partnership is doomed, and it becomes all about a competition between the parties and no one wins.

I believe doctors should be rewarded by a combination of productivity, quality and value. As a hospital employee, income, under most circumstances, is not determined by the patients’ ability to pay. The hospital ensures all staff paychecks regardless of the financial position of the patient. I believe everyone should have “skin in the game.” It should not be all about the bottom line and dollar sign.

Perks of a Private Practice

I’m sure most medical professionals would agree that the primary reason to work independently is for the autonomy. The restrictions and policies enforced by hospitals make it extremely difficult for employees to do their jobs efficiently at times. When it comes to hiring a new employee or implementing new protocols, hospital bureaucracy tends to make all of these processes remarkably slow and more complicated than necessary. Private practices are not subject to the same scrutiny as non-profit hospital organizations. Physicians are used to making decisions regarding patient’s lives in split seconds and don’t usually respond with much patience to the multiple layers of bureaucracy to reach the same decision that was suggested in the first five minutes of a discussion.

Two other definite advantages to private practice is the ability to affect patient care and work flow without the delay of going through various committees. The staff also seem to take more ownership in the more personal, smaller working environment. Secondly, and of significant importance, is virtually all testing can be done at tremendously less cost in the private world as the overhead required by the hospital is taken into account regardless of the procedure or test. In private practice, the cost of a test is based on direct overhead and therefore vastly reduced in comparison.

How to Choose

My caution to any physician or group regardless of specialty when considering the option of independence versus employment, is know the organization’s impression towards physician partnerships and leadership roles in as much detail as possible. Remember the best judge of future behavior is past behavior. If there is any doubt regarding trust, commitment and transparency, think twice before you sign on the dotted line. The grass is not always greener on the other side.

If you have any questions for Dr. Sandler or any other CVG team member, please visit our website at: www.cvgcares.com.