Practice Patterns: Young Oncologists Seek Benefits of Larger Practices, Hospitalist Jobs

Victoria Stern, MA


December 17, 2014

In This Article

Hospital Employment vs Private Practice

Just a few months into a hematology/oncology fellowship at the Mayo Clinic in Jacksonville, Florida, Amanda Shreders, MD, is already contemplating her move into the oncology workforce.

Although Dr Shreders is surrounded by academic medicine, she is leaning toward private practice.

"It's true that the stability of an academic job is quite tempting, but I'd prefer to go into private practice solely to avoid the research aspect of academic medicine," she said.

Dr Shreders, however, understands why there is such a strong push toward hospital-based employment and away from private practice. Entering private practice, especially a small one, can be risky.

"Often, the issue with private practice is that it doesn't offer good compensation or hours, while hospital-based jobs tend to provide a better work-life balance," Dr Shreders said.

This is why Dr Shreders is only looking at larger private practices with at least 15 to 20 oncologists. She hopes that working in such a setting will offer her better hours and compensation, allow her the opportunity to subspecialize, and help alleviate some of the expense associated with running a practice.

But, she acknowledged, "If I could find an oncology hospitalist position or a hospital-based job that wasn't heavily research-oriented, I would definitely choose that because of the malpractice benefits and coverage in terms of call."

Dr Shreders' job preferences echo a growing movement in the oncology workforce. "The days of physicians trying to establish solo or small group practices are slowly fading," said David Peace, MD, an oncologist in the division of hematology/oncology at the University of Illinois at Chicago.

Not long ago, you'd see many entrepreneurial physicians in small or solo group practices that controlled all aspects of the operation. When older physicians wanted to retire, they would sell their practice to a young protégé.

"Older physicians would essentially sell the reputation of their practice," said Cody Futch, a senior recruiter at physician placement firm Merritt Hawkins. "They would vouch for the new physician, and the majority of patients would stay loyal to the practice."

Today, however, just because a physician buys the name of a practice and the patient charts doesn't mean that patients will continue to support it. "Patients don't necessarily have the same loyalty to a physician's practice as they used to," Futch said. "Sometimes patients are compelled to change doctors because a physician's office drops or changes insurance plans, but overall, patients seem more comfortable switching doctors."

Younger physicians running a business today are also faced with serious financial headaches that previous generations didn't necessarily experience. In the era before electronic medical records (EMRs), when physicians would purchase a practice's office equipment, the equipment would be workable for several years.

"Now, with rapid advances in technology, the odds are that older physicians haven't updated their equipment in quite a while and may not have an EMR, so the burden would rest with the young physician," said Futch. "Why would a young physician purchase an outdated practice when they could work for a hospital that will pay them a decent salary and may even provide a signing bonus?"

That is why most young oncologists are looking for positions in larger, well-established organizations, including universities, hospitals, and private practices with many physicians. Larger institutions provide a more protected environment, often shielding physicians from the financial difficulties of running their own practice, exhausting 24/7 call schedule, and time-consuming bureaucratic and administrative duties.

Another major benefit to working in a large academic institution or hospital is access to care. "Because the Mayo Clinic is such a sprawling institution, people who have failed several lines of therapy still have options to participate in clinical trials that can increase their chances of survival," Dr Shreders said.


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