1. DETERMINING WHAT KIND OF PRACTICE TO ENTER Academia? Large group? Small group? Hospitalbased? Decide what fits best for you. Practice types are generally divided into four broad categories – hospital-based, private practice, academia and military practice. Read more about each below. NOTE: Three young urologists share their personal perspective on practice type and more in Appendix E. WATCH: AUA2019: Choosing a Practice Model that Works for You in a Constantly Changing Environment WATCH: AUA2019: How to Pick the Right Practice and Be Successful
LISTEN: Eugene Rhee, MD, MBA discusses sketching life after training on an episode of the AUA Inside Tract Podcast.
1.1 Hospital-Based Salaried employment as a hospital-based physician can be seen as a way to escape the increasing administrative burdens of the profession and/or achieve a more satisfactory lifestyle – especially in a health care environment that is in flux. Advantages: • Guaranteed salary (typically with an incentivized plan) • Built-in retirement plans • In-house management of administrative affairs (e.g., human resources oversight, billing and collecting, rent and overhead, daily operations management, etc.) Challenges: • Not being in charge • Patient population defined by the needs of the hospital system
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• Possibility of compensation changing and/or being evaluated on pre-determined metrics (e.g., quality and patient satisfaction measures) as part of your overall compensation plan Unique opportunities in this practice type include the ability to climb the career ladder to manage multiple practices or become a leader within the organization. Hospitals may be a stand-alone entity or part of a hospital network such as Kaiser Permanente, Mayo Clinic, Cleveland Clinic, Veterans Affairs, an HCA (Hospital Corporation of America) affiliate, etc. If considering employment at a hospital, become familiar with the satisfaction level of the physicians employed there. Consider reaching out to current contracted physicians at the hospital for a better understanding of their satisfaction level with their contracts. Reaching out can also provide you with an opportunity to ask questions and seek advice that may help in negotiations.
1.2 Private Practice Private practices can be organized as a corporate model (where physicians are shareholders) or where one or more physicians owns the practice and employs other physicians or providers. Physicianpractices are often incorporated for tax benefits as well as to protect owners from liability. Owners generally take a salary draw, split any receipts after all expenses are paid, and typically distribute receipts monthly or quarterly; it is often an “eat what you kill” model. This practice type can include solo practices, small or large single-specialty groups or a multi-specialty group. Advantages: • Often provides more control over how one individually practices, including the physical set up, management of the electronic health record (EHR)/health informatics system(s), employee selection and what type of patients are seen and how they are treated • Generally allows for decisions to be based on the interests of the owners/stakeholders versus those of an entire health care system • Partial ownership in the corporation can provide financial incentives separate from those received when caring for patients in the clinic, hospital, or operating room Challenges: • Compromising with the interests of partners that may differ from yours
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