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“Privademics” – Is it real or a mirage?

Home Practice Management “Privademics” – Is it real or a mirage?

  • Avatar Tim 
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    Status: Accountant
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    Joined: 09/18/2018

    Hospital provides multiple hospitals and clinics.
    Medical school needs spots hosted for MS, residents and fellows. Medical school has its own teaching staff.

    Hospital has bought out a number of specialties. Attendings continue to work under contract with incentives. They groups retain management of the operation. The hospital system has separate groups dedicated to research with some practice responsibilities. As an attending, zero responsibilities to research or publish, just teach in the or and clinics.

    Seems like half private, 1/4 hospital, 1/4 academic.
    For example: Day 1 hire or request personal MA and PA.
    You control when and where they work. Hire fire authority. The three current need another “partner”. For example, this isn’t sink or swim. Day one you are going to be comfortable running a clinic in the morning and squeezing in a few or or the outpatient clinic. Buddy system until you are ready to go on your own. Sure it’s some waste, but it’s a ton better than a crash.

    You want to publish, residents and fellows would die for the chance. You simply need to do it, but you won’t get paid and you will need to network for like the research support that the big academic centers provide.

    Is snake oil being sold or is privademics real and any pitfalls (besides the hospital could screw it up).

    #189774 Reply
    Liked by Tim
    Dreamgiver Dreamgiver 
    Participant
    Status: Physician
    Posts: 812
    Joined: 03/09/2017

    Most people in private practice don’t care to teach or publish. So my first question is whether you care or not. If you do, probably academic path is better since you get a professorship salary and protected administrative time and taking twice as long to complete a case won’t matter. Other issue is how quickly these arrangements can change and all of a sudden what is expected of you changes dramatically without you having any input in it. I know some people like teaching a little so they’ll have a med student around. Having the expectation of training a resident is a whole different ball game. Cases take much longer, OR stuff won’t like that, you actually have to teach and supervise and train and correct and evaluate. This all takes a lot of time, more than most people appreciate, especially with junior residents. Senior residents can help a lot and their lower efficiency can be made up, financially, by potentially hiring one less midlevel.

    #189791 Reply
    SerrateAndDominate SerrateAndDominate 
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    Status: Physician
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    Joined: 02/01/2018

    Depends on the specialty. I had a few attendings in residency who weren’t on a tenure track and just got paid their salary. Can’t rmemeber what it was, but all they had to do was teach. Still more academic than private in terms of responsilities and pay.

    I don’t know how the payment system works out for those big hospital takeover situations. My fellowship institution has taken on many satellite hospitals, but I think some of the absorbed attendings had a few demands that were met (case load, salary, etc).

    Earn everything.

    #189793 Reply
    Liked by Tim
    Jaqen Haghar, MD Jaqen Haghar, MD 
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    Status: Physician
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    Joined: 07/27/2017
    alpha investing

    I’d pick one or the other.

    I’d say that I’m in a situation sort of like this.  Private group but under the thumb of the hospital.  Went from MD and PA set up, to the addition of PGY 1-3 residents all day-every shift   It can be OK, but over a few years, productivity down, efficiency down, patient satisfaction scores down, attending income way down 🙁

    The residents are nice and most try hard, but they are just learning, and they need a lot of time, a lot of effort, and not all of them are even teachable.

    Today I went into a room, examined a patient, put in orders, wrote the note, and DC’d the patient for a simple complaint.

    20 minutes later a resident walked over and told me he was going to see the patient (we had apparently both signed up at the same time).  They were still on the board but had been discharged by the nurse.  Had they been seen by a resident, they would still be waiting, probably would have had some testing ordered, we would have had a lengthy discussion about the case in 20 more minutes, and the whole process would have taken not 2x as long, but 4x as long in effort and time.

    I’d say it can be risky also, and many shifts I’d say I pick up about 3 life threatening conditions (gram negative sepsis, missed MI, missed PE, incarcerated hernia, dissection, etc…) missed by residents on the cases.  Of course they never miss out on the the septic workup for a 20 year old strep throat though!

    Clinic work may be a lot different than a busy hospital setting though.

    A lot of comminity hospitals see $$$ signs with residencies.  Of course if they can pawn off the expenses and time commitments to you… even better.

    #189809 Reply
    Liked by Dreamgiver, Tim
    Avatar Tim 
    Participant
    Status: Accountant
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    Joined: 09/18/2018

    Thanks for all the points. Ortho with two subs after spending eight years it’s kinda hang gliding . It looks sooooo cool running and jumping off the cliff. Soaring and swirling and it’s amazing seeing the videos. How the heck am I going to land and how in the world am I going to get back to my car?

    Moving up the “ladder” for 8 years one always a group with a vested interest and an attending to take the “extra time” to get you up to speed.

    So much is written about the “failure rate” in picking the first job. It seems like academic is so familiar but if you get off of the “ladder”, how the heck would you get back on?
    Lifestyle and money leads to private.
    Safety and the known leads to academic.
    Privademics could be nice, terrible, great or a disaster.

    Hey, it’s just a job! Right?

    #190104 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2510
    Joined: 01/03/2017
    I’d say it can be risky also, and many shifts I’d say I pick up about 3 life threatening conditions (gram negative sepsis, missed MI, missed PE, incarcerated hernia, dissection, etc…) missed by residents on the cases.

    Click to expand…

    If this is true, you’ve got a large, large problem on your hands…especially if these are EM residents.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #190108 Reply
    Zzyzx Zzyzx 
    Participant
    Status: Physician
    Posts: 150
    Joined: 09/24/2018

    I don’t understand your question or if you even have one?  I’ve worked in PP, hospital system with a community training program, and an elite University and can tell you there are HUGE differences in all 3 and your assessments are wrong.

    if you want lifestyle and money DON’T go PP (unless you are cash only and do not take any insurance) – you work 24/7 and profit margins are piss poor

    Academia is not necessarily “safer” – changing of chair, chief, dean, PD, funding, etc can completely upend your career

    privademics is a huge time sink with more risk than reward, no monetary compensation (no RVU’s for teaching), minimal recognition, and as always … the hospital will not love you back

     

    It’s psychosomatic. You need a lobotomy. I’ll get a saw.

    #190146 Reply
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1067
    Joined: 11/07/2017

    Thanks for all the points. Ortho with two subs after spending eight years it’s kinda hang gliding . It looks sooooo cool running and jumping off the cliff. Soaring and swirling and it’s amazing seeing the videos. How the heck am I going to land and how in the world am I going to get back to my car?

    Moving up the “ladder” for 8 years one always a group with a vested interest and an attending to take the “extra time” to get you up to speed.

    So much is written about the “failure rate” in picking the first job. It seems like academic is so familiar but if you get off of the “ladder”, how the heck would you get back on?
    Lifestyle and money leads to private.
    Safety and the known leads to academic.
    Privademics could be nice, terrible, great or a disaster.

    Hey, it’s just a job! Right?

    Click to expand…

    I don’t really follow your question (I mean, I kind of do, but sometimes there’s only one way to find out if a practice setting is right for you and that is to try it–and if it doesn’t work out, it’s not a failure, it was a learning experience)…but that hang gliding story is pretty insane.  I’m guessing from the scenery it was in Europe (looks like Switzerland or Austrian/Italian Alps?) where at least my perception is it tends to be less litigious so I’m wondering how that all shook out.  Hang-gliding is still on my bucket list!

    #190155 Reply
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 2629
    Joined: 09/18/2018

    @anne,
    Manager of car parts store in FLA! Switzerland.

    #190160 Reply
    Jaqen Haghar, MD Jaqen Haghar, MD 
    Participant
    Status: Physician
    Posts: 194
    Joined: 07/27/2017
    medical school scholarship sponsor
    If this is true, you’ve got a large, large problem on your hands…especially if these are EM residents.
    Click to expand…

    Yup.  Sure do.  It looks like it it “exit strategy time”.   The problem is the hospital did this for the money, with no intention or emphasis on training.  They actually didn’t even pretend otherwise.   A few docs got out when this started a few years ago. They were the smart ones.

    I stuck it out, but thinking that it wouldn’t be good.  Seeing 3-4 patients per hour, then just throwing in a bunch of residents, resulted in losing 1 patient per hour, and it’s still too fast a pace for a training environment.

    Community medicine standards of seeing patients immediately, excellent customer service, fast throughput times, and perfect care, don’t seem to mesh well with a ton of residents just learning the ropes.

    #190207 Reply
    Liked by Tim, CordMcNally
    Avatar snowcanyon 
    Participant
    Status: Physician
    Posts: 486
    Joined: 10/22/2018

    I think 3-4 pph is crazy, even in without residents. Did this include low acuity PA patients that you don’t actually see, or only patients you see primarily. Agreed that’s not possible with residents, nor is it a fair learning environment for them. But it also sounds verging on unsafe without residents. Unless you were making $300 plus an hour, it sounds like the job was never worth it.

    #190320 Reply
    Jaqen Haghar, MD Jaqen Haghar, MD 
    Participant
    Status: Physician
    Posts: 194
    Joined: 07/27/2017

    I think 3-4 pph is crazy, even in without residents. Did this include low acuity PA patients that you don’t actually see, or only patients you see primarily. Agreed that’s not possible with residents, nor is it a fair learning environment for them. But it also sounds verging on unsafe without residents. Unless you were making $300 plus an hour, it sounds like the job was never worth it.

    Click to expand…

    All patients seen.  PAs would assist with many procedures, and see lesser acuity patients with you and help move them through.  I agree, it’s not for the faint of heart, but honestly it was hard but doable in the past, and the money was top notch (>300/hr).  The whole system has to be set up for this type of pace though.  It was good, if you like working hard.

    Now, it’s a different story.  Outside of the area of my strengths.  So it’s probably best I move on before too much longer.

     

    #190344 Reply
    Avatar ZZZ 
    Participant
    Status: Spouse
    Posts: 566
    Joined: 06/18/2018

    The main pros of private practice are that you’re an owner and can therefore choose your benefits, utilize tax advantages of ownership, and have some modicum of control.

    The university can call the arrangement whatever it wants, but you’re not going to be an owner.

    #190384 Reply

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