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Practicing Medicine

There are many different settings in which physicians practice medicine. The following is a brief discussion of a few types. Note that this is by no means an all-inclusive or comprehensive discussion, but rather an attempt to give an overview.

Group Practice

Most physicians today join existing group practices rather than starting their own. There are several benefits to joining an existing practice. These include lower or no start-up costs and shared call schedules, among others.

Several physicians sharing call (say 5 physicians, each taking every 5th week of call for all of the patients seen in the practice) can be a huge plus in a group setting. Often, in solo practice, a physician is responsible for all of his or her own patients all of the time, taking call essentially every night, unless other arrangements are made with other physicians of the same specialty.

Financially, when finishing residency, most residents are not exactly wealthy, but instead may owe from $100,000 to $250,000 or so in student loans. Additional practice start-up costs and the potential of having to build up a practice for several years may not be very appealing - or even impossible for some new physicians just out of residency.

Most often, already established practices are looking for physicians to recruit and pay a yearly salary or some other financial package based on performance. In other group practice settings, physicians get together to jointly finance a building and share office staff and other expenses, but each physician bills patients separately and remains more independent - not as employee.

Of course, many physicians are employed by HMOs and other large healthcare companies or hospitals, drawing a fixed paycheck or performance based pay.

Other financial concerns are the costs to maintain an office, collections, malpractice costs, etc. that may make employment much more appealing than maintaining a solo practice.



Solo Practice

Often, solo physicians have arrangements to share call with other physicians of their specialty, despite the fact that they are not sharing part of the same practice. Solo practice is becoming less common, but exists and many physicians still seem to prefer this type of setting, especially if they are more entrepreneurial. Also, depending on geographical location in the US, the number of solo physicians seems to vary. In some areas, it is harder to compete in solo practice due to patient demographics and health care reimbursements, so that group practice seems to be the more attractive option.

Academic Medicine and Hospital Based Medicine

Another type of setting is in the hospital as an employee or an individually billing physician who spends his or her entire time in the hospital setting. An example of this is an anesthesiologist or an intensivist who works in the intensive care unit of a hospital and does not have any other patients other than those who are referred to him or her for specialized care from other physicians. Anesthesiologists take care of patients during surgery.

Also, academic medicine, working as clinical faculty associated with a medical school or residency program, presents a unique type of environment centered around the hospital setting. These types of physicians, in all of the specialties, draw a regular paycheck from the university and don't have to worry about collecting on bills, staffing issues, malpractice insurance, etc. as many other physicians do.

They are typically surrounded by residents and medical students who do a lot of the daily routine work for them. They teach and are part of the educational program for medical students and residents. Academic physicians can also be involved in basic science teaching at a medical school.

Many academic physicians dedicate 3 to 4 days a week to patient care, one day to teaching and one day to research, but there seems to be some variation in how much time different individuals spend on each activity. Particularly subspecialties which are very highly specialized are typically only found in larger teaching hospital and academic settings. Smaller hospitals do not supply enough patient cases to sustain a specialist that is highly specialized and, therefore, these physicians often work in university/academic hospitals.

Some of the children hospitals around the country are examples of this type of setting and most often associated with medical schools. Most average hospitals do not have physicians that are trained in the more subspecialized pediatric surgical specialties, pediatric intensive care or other pediatric subspecialties, for example.

It is also worth mentioning that many academic physicians also maintain their own private practices on the side.

Military Medicine

The military offers scholarships ("HPSP" for example) that pay for all medical school expenses, including tuition, fees and books and a monthly stipend. In return, graduates owe them years of service in the military as a "payback". There are also certain residency stipulations.

Some physicians decide to remain in the service until military retirement and then enter private practice. Others only put in the minimum time required to fulfill the payback.

Attending the Uniformed Services University of the Health Sciences (medical school) is another way to enter the military while in medical school and receive officer's pay instead of a stipend, with all education expenses paid in full. The payback is longer for this option, but you earn full officer's pay while in school as well.

Whether just paying back the minimum time or staying in longer, military medicine simplifies many aspects of medicine such as billing, malpractice, etc. Benefits or drawbacks, depending on the viewpoint, are potential international moves and more frequent relocations as well as potential deployments to war zones or crisis areas. Some physicians enjoy military medicine and the officer benefits as well as seeing the world. Others prefer to avoid the military option for the same reasons.

You can find detailed information about these scholarship options in the Money and Finances section.


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