By Vasilios J. Kalogredis, J.D.
One of the nice things about a medical degree and subsequent training is that there are many possibilities available for a physician to utilize his skills. There are many opportunities for less than full time work. This article will focus on options available to physicians who no longer want the full time daily grind of clinical practice.
I have been advising physicians for over 25 years. Over the past few years, I have seen more physicians than ever walk away from full time clinical practice, not to fully retire, but to move to a new full time career (usually using their medical training) or to a less active clinical situation.
In assisting a physician in evaluating his options, I like to determine the primary factor(s) in the decision to make such a change. Understanding those factors makes it easier to determine the best next step for that doctor.
Are there personal health issues? Are there time demands caused by the need to assist others (e.g., parents, spouse, children, etc.)? Has one’s personal financial situation progressed to the point where the physician no longer “needs to work” to educate children, retire comfortably, etc.? Is it just not fun anymore? Has the malpractice insurance premium jumped so high that a change is merited? Does the physician want more freedom and flexibility? Has the doctor “had it” with having to manage a medical practice and worrying about making a payroll? Does the physician love marketing and management, while tiring of the grind of full time clinical practice?
Many physicians are able to find what they are looking for within their present group practices. One of the hallmarks of what a good group practice may provide its community is continuity of care. The doctors in the group know and can care for a patient “forever,” not for just the professional life of any one doctor.
A physician no longer desiring full time work with on call responsibilities may still benefit the practice. That physician might only see patients in the office. That physician might work a full time office schedule, with no on call duties. That physician might work a less than full schedule (e.g., 50 percent time), either with or without call duties. Such a physician might work a full schedule when working, but be entitled to substantially more vacation time than the other group doctors. A less-than-full time doctor might only work to cover vacations, night call and/or weekend call.
In a surgical practice, a physician might only have an office practice or assist in surgery, without doing any “majors” himself.
In an Ob-Gyn practice, a doctor may decide to drop OB and/or surgery entirely.
In several groups I work with, one of the physicians has been designated as the “Managing Partner.” In those situations, it has been agreed that a certain percentage of that doctor’s work week is to be devoted to managerial, non-clinical, activities on behalf of the practice. That time is built into the schedule. It works well in those settings where a doctor has good administrative and entrepreneurial skills and interests and the others do not mind his taking that on.
In all of the above scenarios (and others like them), the economic arrangements to make things work fairly for the parties involved can be worked out if the parties are motivated to do so.
If properly structured, everyone wins. Patients continue to have access to a good and well-respected physician, albeit on a less-than-full time basis. The physician gets to do something he likes doing, while giving up most, if not all, of the parts he does not like as much and/or is no longer capable of providing. The physician also gets to utilize and maintain his skills and continue to benefit the community. The physician gets to maintain the professional and personal relationships he has developed while practicing. The practice retains the experience, drawing power, name and goodwill of the physician, as well as the clinical contributions he can still provide to the practice and its patients. This is a common occurrence.
There are many other opportunities available as well.
Some physicians seek total freedom and flexibility and work as locum tenens. This allows them to work where and when they want to. They can return home and be totally free of any work responsibilities. They can help cover extended vacations, disability and death situations. We recently had an ENT client who became disabled and the practice was “saved” by bringing a locum tenens in until a more permanent physician was hired to cover things.
Some become “seasonal physicians,” working hard in resort areas during the busy season only. One example is a client who decided to retire on Cape Cod. He works hard for about one-half of the year and takes the “off season” off. He is delighted. The group he works with loves having a capable and experienced physician during the busiest times, without the burden of having to pay a full year’s compensation package. It is a “win/win” situation.
Other doctors decide to do only nursing home work.
Some physicians turn to research, teaching, speaking and expert witness work. These avenues can be mentally stimulating and challenging, while still taking advantage of the physician’s skills and experience.
Some are attracted to positions with pharmaceutical companies, in research, education, sales, administrative and other capacities.
E-Commerce has also become an opportunity of choice for many physicians. Be it electronic medical records, billing, patient education, marketing, doctor education or other areas, several physicians I know have made this area their full time or part time career.
Organized medicine is another area where physicians can make a great contribution. Be it the AMA, AOA, state or county medical societies or specialty societies, there is a real need for capable and caring doctors to make a difference. Malpractice insurance and HMOs are among the areas where a concerted effort could have a positive impact.
Politics, which seems to have drawn most from the legal ranks, has begun to draw increasing numbers of physicians to it over the past few years. This includes elected officials (including in the U.S. Senate) and appointed officials (Surgeon General) at all levels of government.
Many physicians have gone on to earn additional degrees (MBA and J.D. being two of them) and are pursuing dual careers. One of my clients spends three days a week practicing medicine and two days a week tending to her law practice (which primarily focuses on malpractice defense).
Many physicians have pursued administrative careers in business, health care consulting, with insurance companies, HMOs, hospitals, practice management companies, pharmaceutical companies and universities.
A doctor’s clinical experience and front line involvement can prove to be invaluable in many settings. For example, some of the more successful hospital and physician practice management company executives have been physicians. That background made it easier for them to relate to other doctors, in comparison to many others.
The options are limitless.
Vasilios J. Kalogredis, J.D., is Founder and President of Kalogredis, Sansweet, Dearden and Burke, Ltd., a boutique health care law firm in Wayne, Pennsylvania.