You’ve completed your graduate degree and perhaps a residency and fellowship. Congratulations! As you map out the next steps in your career, be sure to understand the structure, ownership and governance of any organization you may want to join. That has implications for your workload, compensation and “voice” on the job.
“There are pros and cons with every organization and position. It’s important to be self-reflective on what you want to do and to understand whether an organization will support your goals,” says Rich Green, M.S.P.T.’92, chief executive officer of Des Moines Orthopaedic Surgeons in Des Moines, West Des Moines and Ankeny, Iowa, and a member of the DMU Alumni Board.
Here are some basic key questions to ask.
Who owns the organization? Is it a nonprofit health center with a governing board made up of non-medical individuals, such as local citizens or clergy? Is it a physician-owned clinic? Is it a teaching hospital or one owned by the government, as a Veterans Health Administration hospital? Is the organization owned by a private equity firm that prioritizes profits?
The type of structure an organization has offers insights on another key consideration: Who makes the decisions? For example, UnitedHealth Group owns physician groups, health care facilities and the largest health insurer in the nation, UnitedHealthcare. How does that affect patient care and safety? (In February, the U.S. Justice Department opened an antitrust investigation of UnitedHealth Group.)
Green says that at DMOS, which is a private physician-owned practice, the physicians can become partners after two years. That gives them a voice in operational decisions. At a nonprofit hospital, employees may be appointed to committees that make recommendations but don’t have final say. However, those providers may spend more time in patient care and less on administrative matters.
The takeaway: Know what level and type of control are important to you.
What factors are involved in my compensation? Beyond a salary, does an organization require the providers to see a minimum number of patients in a day or week? How does that affect time spent with patients?
Some positions offer compensation based on Relative Value Units, in which providers are paid more for managing more complex procedures and services. Simplified, they earn a specific number of RVUs based on the types of services rendered. On one hand, RVU-based compensation rewards providers for taking on more work, complex patients and challenging procedures. On the other, that approach can drive a highly competitive work environment among the providers and may discourage practices from taking on lower-paying Medicare and Medicaid patients.
Fixed salary compensation models may create less pressure on providers to work faster and treat as many patients as possible, but that may limit their earning potential.
“Medical students and new graduates typically are excited to take care of patients and are eager to pay off their tuition debt,” Green says. “Then they find out, ‘I’ve got to see how many patients a day?’ You want to understand the compensation parameters to make the decision that works best for you.”
How can I build my practice within the organization? As a new provider within an organization of any size, you’ll want to know how patients are assigned to you. Will you have a say? What will be your mix of private-paying patients and those using Medicare or Medicaid? How will that affect your actual compensation? Will you be put on call? If so, how often, and how will that affect your pay?
“Health care is so much different from when I graduated from DMU’s physical therapy program. Students and new graduates need to have some knowledge of health care’s business and financial aspects,” Green says. “One type of structure or governance isn’t necessarily better than another, but understanding the impact on one’s day-to-day practice and compensation and how that fits one’s goals and values are important.”
