Solo doctors have alternatives to hospital employment

Independent doctors, before you hit the panic button and become employed by a hospital, take a deep breath. There are alternative options out there.

Those alternatives and what it takes to make those options successful were discussed during a late afternoon session on Tuesday at MGMA-ACPME’s annual conference in San Antonio.

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Independent doctors are going to hear, if they aren’t already, a lot of warnings about not becoming employed at hospitals, said Chuck Peck, MD, president and CEO of Health Inventures, a Colorado-based company that facilitates physician-hospital alignment.

“It’s going to sound to you like people describe being in their house when a tornado is coming,” said Peck. “They describe this awful noise: ‘It sounds like a freight train.’ The fright before the destruction, and all that. You’re going to start feeling like you’re the only people in existence that haven’t run to be employed by a hospital. You’re going to hear people tell you … that within the next five years, 90 percent of the doctors in this country are going to be employed. That is absolutely false.”

While it may be tempting to give into your fear, take a step back, said Peck. Within five years, a majority of doctors will be in some sort of partnership, Peck said, but that partnership doesn’t mean, necessarily, being employed by a hospital.

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“… (W)hen you’re making decisions at the same time you’re pushing the panic button, as opposed to a thoughtful strategic decision, a lot of times (you make) the wrong decision,” he said. “It may not be the wrong decision to get into a relationship with somebody, but who you get in a relationship with may be the wrong decision.”

Peck said that there are many partnership models that physicians can look into beyond being employed by a hospital. He touched on three: joint venture management services organizations, captive professional organizations and joint venture physician services organizations.

But the main thrust of his session was to convey the importance of culture in any partnership, whether in one of the models he showcased or in a hospital employment situation.

“We love to sit on our high horse, I think, and have discussions in public about quality, but let’s just get real. At the end of the day – at the end of the day – it’s about who controls the cash,” Peck said. “… (I)f the culture’s not right, the thing that’s going to cause you to get divorced after a very short marriage is going to be money. … (I)t’s going to boil down to you’re pissed off because you’re not getting paid enough, you could never get paid enough to put up with the crap you put up with every day.”

To avoid a bad partnership, Peck told doctors:

• Don’t push the panic button and don’t believe the fearmongers that tell you if you don’t become employed by a hospital, you’re dead.
• Start looking at partnership options before you are up against a wall.
• Investigate all your options – hire a knowledgeable lawyer to help you out and represent you in partnership negotiations.
• Know what you want and why.
• Get educated – understand business and management.
• Doctors and business administrators and managers have very different cultures. Understand how you think and approach the world and how managers and administrators think and approach the world.
• Create a business strategy that puts the goals of the partnership ahead of what’s best for you and your practice and what’s best for your business partner, and, most importantly, puts the patient at the center of every decision.

“Culture eats strategy for lunch,” Peck stressed. No matter how much work you do investigating the perfect partnership for you and your practice, no matter how great your business strategy is, if the cultural alignment is off, he said, the partnership won’t work.