Primary Care Choice: Team Leader or Single Player

The difficulty is the choice.

George Moore (1852-1933), The Bending of the Bough

Primary care physicians face a difficult choice:

• Be a leader of a team of physician assistants and nurse practitioners., and a salaried employee.

• Be a direct pay, concierge physician practicing on your own.

Why is this choice difficult?

Because the choices demand a different set of expectations and skills, neither of which is taught in medical school or residency.

• If you take the team route, you will expect the organization that hires you, generally a hospital, to do your marketing and the recruiting of your team for you.

This is a powerful incentive. The hospital has a recruiting and marketing staff and can advertise your presence on television and other media. Furthermore, you have guaranteed benefits and regular hours. You can lead a balanced life. You will have a built-in computer system. You will have to spend time meeting with your staff, training them, leading them. Your staff can handle routine matters, and you can devote your time to complex matters requiring clinical judgment , such as whether to refer to a specialist, who will probably be part of the hospital’s larger medical group. Your employer, the hospital, will take care of the marketing, business, and the insurance-related paperwork.But you may miss doing what you envisioned the role of a primary care physician to be - spending time with patients and making autonomous decisions on your own based on your solo clinical judgment.

• If this is not your cup of career tea, you may choose to become a direct pay/concierge/ retainer physician. Your decision carries risk of failure. You will have to do your own marketing to make your presence known in the community. For this task, you will have to develop marketing skills, which may involve setting up a website, using the Internet, speaking before community groups, informing local businesses about your practice, relating to the local media, or telling your patients to spread the word. On the other hand, you can devote most of your time to your patients, who will probably number 500 or 600 rather than 2000 or more in the usual practice. You can have a small staff, one or two rather the 5 or 6 in the traditional practice You can cut your overhead by 50% or more because you no longer have to deal with insurance companies or government Medicare and Medicaid bo-betweens. You no longer will have to deal with such business matters as accounts receivable. Patients will pay you by monthly or annual retainer or by cash-only. You can make your own clinical decisions. You can spend as much time as you want with patients. You can assure them you are available 24/7 by email or cell phone. You are your own person rather than an employee of a larger organization. Clinical decisions are strictly between you and your patient. Your time is your own, you can choose your patients, and they can choose you. You will not be overwhelmed and overloaded by those new crowds of Medicare, Medicaid, and health exchange patient generated by government programs.

It is a hard choice, and only the primary care physicians can make it, whether they are ready or not.