Rheumatologists Weigh Pros, Cons of Working in Academia

Of course, hospital employment has some downsides, too. “It is difficult to make changes to how a practice is run at a large academic institution,” says Dr. Criscione-Schreiber. “However, we have a relatively small division of 14 rheumatologists on our faculty, so we are able to pilot changes fairly readily.” Clinic staff have their own management structure, so faculty partner closely with the nurse manager and other staff supervisors to work toward agreeing on changes.

Dr. Fernandez has similar sentiments. “The size of a hospital means that making changes can be challenging, because it requires navigating various channels when reaching consensus,” he says.

Regarding income, “When comparing salaries in private practice against those in hospital-employed practices, a lot depends on where you stand in the organization,” says Dan Jennings, regional vice president of the Atlanta-based The Medicus Firm, which places physicians of all specialties in both hospital and private practice settings. “If you own or are a partner in a private practice, then you will more than likely have a higher income than your counterparts who are employed by a hospital.

“In fact, a national survey showed that private practice rheumatologists tend to outperform hospital-employed rheumatologists by almost $40,000 annually. This difference may be due in part to the fact that physicians who own their practices have complete control of overhead, retain all of their collections and have the ability to collect on ancillary services. Typically, these are factors that do not apply in a hospital-employed practice, where a physician has a base salary and usually receives a production bonus on work-relative value units (wRVUs) or collections for their professional charges. But this added income does come at a cost, however, including assuming the risk for the practice, taking on the burden of running a practice and time required to run the practice.”

Dr. Abelson

Although the numbers point to private practices as the ideal place to be an owner or a partner, if a rheumatologist has just finished their training or is simply looking to be employed in a practice (and doesn’t want the responsibility of ownership), then a hospital-employed setting will more than likely be the better landing spot financially.

“Our firm has found that through our recruitment efforts, a hospital will have the ability to offer a physician a higher starting salary right out of the gate—typically along the Medical Group Management Association median income,” Mr. Jennings says.

Coping with Challenges

For Dr. Criscione-Schreiber, it is challenging to know that certain changes could make care easier for providers and better for patients, but that the changes would take a long time to become a reality. For example, she has to work in the electronic environment that the health system chooses. “Changes we may want to make to improve our clinical care flow enter a larger work queue with requests from all of the other departments and divisions; we have to wait our turn for the changes to be made,” she says.