Do you want to be an owner or a renter? The benefits of physician independence

Nearly 30 years ago, Roneet Lev, MD, an emergency medicine physician, made a significant decision that would change the course of her career; she opted to leave a large medical group due to management changes. While she initially was proud of being part of the group, issues starting brewing when the group was sold twice to larger organizations, which ultimately took away from the physicians' revenue.

"When they sold a second time, the group said you need to sign with the new group or you'll be fired," Dr. Lev says. "We were very frustrated with the sale, and reluctantly signed on." The group of physicians added a cleaver clause to the contract that stated they would stay for one year and then be allowed to compete for the contract during that year.

"At the end of that contract period, overnight, everything changed; we became business owners, were making more money and we were more productive and happier," Dr. Lev added.

Although independence allows physicians the opportunity to make their own decisions without the layers of bureaucracy embedded in a large organization, the large group management groups have opportunities for collaboration between various hospitals. Dr. Lev wanted that teamwork in the new practice, which spurred her decision to form Independent Emergency Physicians Consortium, which currently encompasses 34 separate independent emergency physician groups that run their own business and are not part a large contract management group. Her group of emergency medicine physicians has a contract with Scripps Mercy in San Diego to provide emergency services to the hospital.

"This way, we have the best of both worlds, small group ownership and large group collaboration of similar minded emergency physicians. IEPC allows us to shared best business and clinical practices," Dr. Lev says.

At Scripps Mercy, the group has made substantial progress in areas such as psychiatry care and behavioral health. The hospital has an eye on tele-psychiatry services so providers can care for patients who cannot readily commute to the hospital for care. At the crux of the group's mission is connecting with community members. Dr. Lev said the hospital is members' "home away from home" and the physicians have relationships with many community members including other hospital managers, public health officials, church and synagogue members as well as their colleagues within other specialties. The group is able to give back to the community through its relationship with local organizations, which Dr. Lev notes is important for career satisfaction.

"We have been a part of this community for 23 years and we are leaders within and outside of the hospital," Dr. Lev says. "We have a tough job and one way to continue to be proud of your profession is being involved outside your shift work in the community."

Career satisfaction is exceedingly important, especially due to the high prevalence of burnout among emergency medicine physicians. A 2017 Medscape report found emergency medicine physicians had the highest rates of burnout at 58 percent. With burnout affecting the majority of emergency medicine physicians, those entering the field have an important decision to make — to pursue employment with a large organization or an independent practice. Dr. Lev tells those making the decision to ask themselves whether they want to be owners or renters.

"You can clock in and out [in an employment model] or you can have a sense of ownership in running your own business," Dr. Lev says. "The physicians who are members of IEPC are proud to be owners and nimble for changes that enhance our business and benefit the hospital and patients. Either way, physician satisfaction is of the greatest importance. Happy doctors, make happy nurses and happy patients."

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