Careers in Hematology: The Private Practice of Hematology
Daniel Rosenblum, M.D.
Dr. Rosenblum is a past Chair of the ASH Committee on Practice and
was in private practice for 26 years.
What are the options for careers in private practice? Which will work
best for you? Use of the kinds of analytic skills honed in your training as
a hematologist may help you find answers.
The spectrum of opportunities for practicing hematology and the
communities in which to practice is very broad. Hematologists are unevenly
distributed in our country. Some communities are saturated with
hematologists; others are underserved. The spectrum of familiarity with
hematologic evaluation and treatment in the general medical community also
varies widely. Therefore, the professional activities of hematology
consultants differ dramatically in different regions.
Solo hematology practices are vanishing. The economic risk required to
sustain a solos practice is often excessive. In large urban areas, groups
are the rule. The need for hematologists is insufficient to sustain a solo
practice in an area with a population less than 100,000. The accompanying
table shows a comparative analysis of the characteristics of various types
of practice. Small groups promise individual independence, but often provide
little buffer against inadequate management skills. Members of small groups
are vulnerable to risks such as personal and family illness, pregnancy,
disputes, runaway overhead, and bad debts. Few small groups survive intact
for decades.
Larger groups usually have more organization, written agreements, tighter
controls, and arrangements for conflict resolution and are likely to suffer
if they don't. Members exchange independence for improved risk management
and reduced vulnerability to unforeseen events. Single specialty groups are
likely to push new members to build personal consultative services or to
assume the load of a senior partner at discounted fees. The terms of the
contract are critical to your career development. It is reasonable to accept
such an arrangement for a few years provided you have a written agreement
that specifies the conditions for full partnership. Without such a contract,
another fresh trainee could replace you after you have devoted several years
to the practice.
Multi-specialty groups may be hungry for help. They have many of the
organizational attributes of single specialty groups, but control can be a
major issue, particularly if a procedure- or hospital-oriented specialty
dominates the group. If you are asked to replace a busy physician who plans
to retire or is suddenly unable to practice, established referral patterns
may keep you busy. If the group plans new ventures, you should check the
details for risks, particularly if the plans are contingent upon your
cooperation. Determine how the revenue stream is divided and conflicts are
resolved. Written agreements are essential to maintain effective parity in
multi-specialty groups.
Corporate employers, whether single or multi-specialty, provide the
firmest support for the new member. Professional management, formal
contracts, and established policies are the rule. Corporations provide
benefits, vacations, sick leave, and retirement plans. They purchase
equipment and control overhead. If the corporation is well-capitalized, your
salary may be protected against revenue shortfalls. You should understand
the performance standards and the consequences if you fail to achieve them.
Freedom is often limited, patients are assigned, and conflict resolution is
apt to favor management. Corporations can fail, however, and your income may
ultimately be linked to corporate earnings.
Before committing yourself to a contract, you should check the group's
sources of revenue, experience with payers, credit rating, outstanding
loans, history of lawsuits, experiences of physicians who have left the
group, and staff relationships. Under favorable conditions, private practice
is an ideal venue for the personal expression and creative talents of an
energetic hematologist, limited only by human imagination.
This article was written in a personal capacity and does not
represent the opinion of the FDA, DHHS, or the Federal Government.
