Private rheumatology practice may offer trainees best balance of profit, job satisfaction
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Understanding the risks and benefits of working in a private rheumatology practice can give young trainees a better chance at job satisfaction and career success, according to a speaker at the CSRO Fellows Conference.
“What is the difference between a large cheese pizza and a private practice rheumatologist?” Herbert S. Baraf, MD, FACP, MACR, former managing partner of Arthritis and Rheumatism Associates and clinical professor of medicine at the George Washington University School of Medicine and Health Sciences in Washington, D.C., told attendees. “A large cheese pizza can feed a family of four.”
Baraf pointed out what most rheumatologists already know: Rheumatology is “not at the top of the food chain in terms of economics.” While working in a hospital or an academic center has its advantages and disadvantages, he believes that working in a private practice may ultimately be the best bet for maximizing the balance of profit and job satisfaction.
However, while a solo practice may come with complete autonomy, there are a number of challenges and practical realities to consider. A solo practice is vulnerable to risk and competition. The overhead of paying rent and staff can be difficult for just one rheumatologist to cover. Expansion may also be difficult, as banks are less likely to offer loans to a solo practitioner than they might be a to a larger group. “There are significant startup and maintenance costs,” Baraf added.
Ancillary services can also be a conundrum. Larger groups may be able to offer imaging and infusion services in-house, while a solo practice may not be able to carry this kind of overhead. This can affect the doctor-patient relationship. “There is a sense of comfort for patients if you can offer a full plate of services,” Baraf said.
Beyond clinical considerations, Baraf noted that when he set out on his own in solo practice, he thought he was “God’s gift to rheumatology,” and expected patients to flock to his office. But that was not necessarily the case. “As an individual, you will not have name recognition,” he said. “It takes a while to build a practice. Most doctors who do well solo are ones who developed a name somewhere else.”
Beyond these recommendations, Baraf noted that the American Medical Association and other such organizations have a wealth of literature on the subject of setting up a solo practice. However, he acknowledged that many young trainees may prefer to seek employment in a group that is already established.
To that end, recent graduates should consider where they want to live and work, and then use resources ranging from Doximity to classified ads to networking with fellows to determine the best fit for a job.
Baraf then stressed preparation before an interview with a group or practice. “The biggest mistake you can make in an interview is not asking questions,” he said. “We want candidates who are constructive, who show accountability, leadership skills, a collaborative mindset, and who are thoughtful.”
After the interview, send a thank-you note, Baraf added. “Gratitude can help your work life,” he said.
Understanding the dynamics of the practice is as critical to landing a job as education and experience, according to Baraf. “Many hiring decisions are based on personality type issues,” he said, and urged trainees to try to understand if they fit in with the culture and vision of the practice.
“You should also know what you are looking for in your career,” Baraf said, and raised a number of questions for trainees to consider. “Do you want full-time or part-time employment? A good personality fit or the highest possible income? Fulfillment? Do you want to do clinical research or have teaching opportunities? Do you want to innovate or are you just looking for a job? These are all reasonable questions.”
In terms of compensation, Baraf encouraged trainees to do their research about pay scales in that region, and to not be afraid to negotiate. “But don’t expect a signing bonus from a private practice,” he said.
Regardless of whether the practice is a duo or a large group with multiple clinicians and services, Baraf offered simple advice for interviewees and new hires alike. “Be humble, be eager, be visible, be accessible,” he said.
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Baraf HS. So You Want To Go Into Private Practice. Presented at CSRO Fellows Conference; March 13, 2021. (virtual meeting).
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