"It seems to me... that it would be helpful for you
to know about some of the negative sides of
becoming a physician employee. My 14 practice
years as an physician employee should qualify me as a
trustworthy person to hear these things from.
(6 in military, 3 at Kaiser, 5 as a hospitalist)"
My military practice experience...
In 1962 the military was drafting medical doctors right out of medical school to prepare for the Vietnam war escalation and the increase in military strength.
My selection was the Navy. My belief was that it was better for me to get my required service out of the way first so that interruptions of my further specialty training would not occur. As long as I knew the Navy was my destination, I requested my internship in the Navy and would plan after that.
I elected to join Kaiser Permanente employment after my OBG residency in 1970 because I had no source of income for my family obligations or for starting a private medical practice.
In the military a doctor has no real choice as to how they want to use you. As a flight surgeon it kept me out of the crappy clinic chaos for the most part. Naval aviation was a formidable challenge and enjoyed my time in it.
Being a naive Naval Lieutenant at that time my thoughts were about being on a carrier with my Navy Squadron that I would be assigned to eventually.
It was only a short time later that I was assigned to a Marine helicopter squadron on the west coast headed for Vietnam. Only then did I discover that the Marines didn't have their own medical personnel and that all medical personnel were assigned by the Navy to the Marines.
After my two year tour with the Marines, a year of that in the Vietnam combat zone, I headed to my OBG specialty training in Philadelphia. Three years later I ended up in California again at
Kaiser Permanente.
My Kaiser Permanente experience...
Kaiser was a completely different game. The major push was to make as much money from patients as possible to pay their doctors enough, and benefits enough, to satisfy their needs, not a physician's expectations by a long shot, and pump up the organization pockets.
That essentially is exactly what all businesses are in business to do, and private practice of medicine business is no different, except that your income is completely dependent on how hard you are willing to work, learn, and compromise some areas of your lifestyle.
I detested being told that I couldn't do infertility work there, which was my career focus. Health insurance at that time didn't cover that part of healthcare primarily because infertility was not considered a disease. As a result, Kaiser would not permit me to spend my medical care time on anything that insurance wouldn't pay for.
I had no control over my patient scheduling in OBG and was completely booked up 3 months ahead, no fit-ins, no medical care after clinic hours. it required seeing patients rapidly to keep up with my patient schedule in order to be done by 4 PM. I happened to be a doctor that felt an obligation to teach and inform my patients, and never had the time to do that. It was a frustration that most good physicians abhor.
At Kaiser I found that the OBG department group of doctors, about 10-12, some being long term employees, all had personal non-professional reasons for staying. One doctor lived and preached golf. Another had family wealth and life was easy there, 9 to 4, no surgery, practiced only with using the medical advice of other doctors in the group. Another had a fascination for heading the department administration.
In spite of the salaries, good benefits, retirement and partnership setup by the third year there, and enormous amount of free time (compared to private practice OBGs) available to them, in my three years there almost half of the OBGs left for private practice, usually into a specialty group, and a couple had been there well over 6 or 8 years and quit. A couple of doctors came and left
in a few months.
The Kaiser program I believe was ideal for female doctors, for those who needed a lot of free time to pursue their family responsibilities, hobbies, or pleasures outside of medical care. It brings up to me the question of why they actually chose medicine as a career.
Maybe it was for the stability of income, the professional status, the challenge to see if they could make it, or the demands of their family (which is often the case). Rarely, does a female physician marry a non-professional male, unless he has a high paying job... too bad male physicians don't think the same way.
I quit Kaiser to practice infertility in my solo private medical practice. And I was only able to do that because one of the local OBG physicians overloaded with patients agreed to feed me a lot of new patients, which he did.
My first year in private practice earned me about $54,000 net, and rose rapidly after that. I spent 20 years in private medical practice which were extremely fulfilling and enjoyable. For financial reasons due to my ignorance of business and marketing, I lost my great practice and joined the employed physicians club, again.
My Michigan hospital experience...
My Michigan hospital tour of duty enabled us to pay off our debts accumulated when the practice disappeared. My experience working with nine nurse midwives was impressive. All were very competent in my opinion and well educated enough to know when to call for help from
staff physicians.
It made me a believer in CNMs and PAs for being an asset to medical practice rather than a competitor. Any physician today that does not take advantage of these assets in private practice is foolish. They are money makers for most medical doctors with busy practices.
The restrictions on practice placed on me while working in the hospital clinic were far more idiotic and extensive than at Kaiser.
The lesson I learned at this job was something that I had suspected along the way in the medical profession, but never thought it was more than competitive personalities. I never had experienced such resentment, hostility, income competition, arrogance, and subtle examples of intentional disgust among medical doctors. Of course, all of you reading this know that physicians never treat other physicians like that. Do they?
I then did some deep thinking about my experiences over the past 40 years in medical practice and concluded that I was naive to think that these things inside the profession were rare events, when in fact it truly runs through the whole profession, varying only in intensity and aggressiveness. They pretend not to spread secrets, disruptive events inside the profession, problems other doctors have, and hope their wives keep silent about all of them.
----Professional Probe----
Your wife did WHAT"?
Articles©2013-2022/CGG INVESTMENTS LLC. All rights reserved. #113, 3-16-22
