This is our story

Working as an employed physician for a hospital system certainly has its pros and cons. The greatest advantages are probably the lack of HR headaches and the guaranteed base salary.

For us, what defined our years as full-time faculty was an endless stream of red-tape in which we felt completely helpless to effect meaningful change.

We prefer a paperless environment if possible, but the hospital would not switch to efax or electronic intake forms. When we tried to integrate new technology into my office, we were met with resistance. 

We had several staffing issues (MA who didn’t show up for work because they had been jailed, an office manager who intentionally hid piles of phone messages to avoid work), but while we were the main doctors in the office, we could neither hire nor fire. We didn’t even have the authority to gently direct our staff member towards improved behavior. 

Although our income was based entirely on productivity, we had minimal autonomy to modify our schedules. Although we were seeing more patients than most of the other doctors, when patients complained that it was too hard to get a quick appointment, we were informed that we would have to add on early hours. 

Patients sometimes gave us low satisfaction scores based on ineffective phone trees, but these trees were created and modified only by the hospital.  We often didn’t get messages, but there was no way to track the breakdown in communication.

It took months to get in to see us, and this was a great source of dissatisfaction for patients. However, we were not allowed to “fire” patients who were habitual no-shows and took up coveted spots.

When we went to re-sign our contract, there was a stipulation that the hospital could decrease our compensation as appropriate should reimbursements to endocrinology decrease in the future. However, they refused to define the lower limits of our compensation. Compensation was also not tied to performance. There was no financial reward for more compassionate/skilled doctoring. 

Making the decision to leave the hospital environment and set up our own practice was one of the most nerve-wracking decisions we have ever made. However, in hindsight, we understand that this was clearly our best professional decision, and we hope this guide will help others take the giant leap towards autonomy.