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Physicians as Employees


More and more doctors are taking salaried positions rather than establishing independent practices, so they'll have to understand two key areas of the employee-employer relationship: leadership and income.

The idea of physicians as employees used to be an oxymoron, but as noted in this column previously, more than half of all graduating doctors are now taking salaried jobs rather than establishing independent small practice businesses. And there is also precious little formal training that is oriented to optimal functioning as a hired hand, respected professional or not, especially in larger medical groups.

Largely ignored by the medical academic establishment, there is a large body of work out there devoted to understanding how to best function in groups such as these. But the scale of the entire employer-employee relationship is far beyond our scope here, so let's just focus on two important areas: leadership and income.

Independent doctors can raise their incomes when desired by seeing more patients or adding a new service or skill. But salaried doctors have to ask for a raise. Most large groups have policies about the means of doing so, and smaller groups may have a clause in the contract about reviews and salary adjustments. But either way a bit of planning will go a long way to a successful outcome.

First of all, you don't deserve a raise just because you haven't received one in a while. And you may be limited by the group as to your scope of practice in terms of time and activities. So you have to plan, execute and then fully document your accomplishments to get an increase.

If you have specific guidelines from your chief (read "boss") that is very helpful. If your boss has not set up specific performance expectations from the beginning, speak up and get them established, preferably playing to your strengths and make sure that there is a timeline for review. He/she will probably be relieved if that activity is not their forte, and you will rise in their estimation.

And keep track of what the outside market is doing as well. Medical groups watch the going rate for new hires very carefully and so should you. Particularly because raises may be compared to what you have received previously, not what you could get elsewhere. Know your worth.

Whether or not more money is available and/or forthcoming, consider obtaining a title, paid or not. And many budgets provide raises just for promotions so keep that in mind. Also be aware that titles are sometimes fobbed off instead of money or as a test to see how you will handle increased responsibility and leadership. Either way, aside from whatever psychic reward is involved, you can leverage the new title as a résumé builder for future consideration — internally or externally.

If you are not successful in getting a raise or promotion, ask why. This may be one of the most important questions of your career. And keep in mind that there can be a "good" reason and a different "real" reason for a negative review. Rarely the latter is not legally or politically acceptable, but keep your antennae up.

Money distribution and governance are the two most contentious issues in medical groups. On the leadership question of functioning in a medical group, we know that born leaders exist — we see them occasionally. But the local need cannot wait for Arthur to show up and pull Excalibur out of the stone. So we should consider learning to acquire or improve leadership skills.

If you want to be a leader, or get a voice in governance or just perceive the need for someone to step up, you should act. For instance, bring one good idea to each meeting. Being consistently better prepared is a mark of leadership. Volunteer to do those things that need doing but that no one seems anxious to do. Also the mark of a leader. And learn to fight adversity with indifference. Resist the temptation to get emotional. Think, act and speak positively. Medicine has a culture of complaint so a positive voice will be noted and appreciated.

And look for a bigger vision of how to solve a problem or improve some function. And don't be afraid to fail. No one bats 1.000 but you get no credit, or results either, if you don't go back up to the plate.

And style matters. Not just coolness under fire, but a ready smile and a professional appearance. Study after study has shown the positive effect of a sharp professional appearance. How many of our colleagues have rumpled coats, with sagging pockets burdened with the tools of the trade? It’s a common look, yes, but detracts from a positive impression. Every doctor who thinks this isn't important will have to walk a steeper slope professionally.

It may sound somewhat cynical, but power is really just the ability to get things done. And if you value that ability in your organization, you have to realize that power is largely a matter of perception. If you think you can do what is needed to be done, then so will your colleagues. The obverse is that if you look, act and think like a subordinate, then that's how you will be treated. Always. But if that is your style and your comfort level, you're lucky to know it.

There is no end of info available on how to function your best and how to accomplish your particular goals in an organizational setting. Be it income improvement or influence upon governance, for two important examples. Just like the substance of the profession, some effort is required to learn how to achieve in a group setting and usually it will be amply rewarded.

It isn't just a brave new world scientifically for the medical profession we live in, but also the dawn of a new service delivery model. There are fewer solo and small practices, and more large groups. Learn to adapt, enjoy the ride and prosper.

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Victor J. Dzau, MD, gives expert advice
Victor J. Dzau, MD, gives expert advice