Fact or Fiction?


Community Health Centers (CHC) provide care to patients of all ages.

CHC provide care to uninsured patients as well as insured patients.

CHC can offer a part-time or full-time outpatient only employment.

CHC offer malpractice insurance through Federal Tort Claims Act, which includes tail insurance.

CHC's retirement plans and other benefits are comparable, or superior, to other medical practices.

CHC are located in rural and suburban areas; however, employed physicians can enjoy city living if they are willing to drive approximately 15-30 miles.

Many of the CHC are providing care with state of the art equipment, electronic medical records and digital X-ray machines.

Many of the CHC are located within 30 miles of a county or regional hospital.

The average response time for the rescue squad to the CHC in Floyd, Virginia, a rural area, is less than 6 minutes.

Specialty support services are usually available for consult visits within 15-30 miles of a CHC.

Due to established sliding scale payment plans and medication assistant programs, caring for uninsured patients is manageable, affordable and not time consuming for physicians.

Referrals for uninsured patients are possible through an established network of specialists who are participating in charity care programs.

Teamwork, patient education, disease prevention measures and health promotion practices are the cornerstones of CHC's mission.


Each of the statements above are fact, not fiction.

So what is wrong with working for a hospital owned outpatient practice?

Being employed by either a hospital owned clinic or by a community health center can offer some similar advantages. In both settings administrative tasks are accomplished by properly trained employees who allow physicians to focus on their clinical tasks. Establishing pools of cross trained employees and available temporary substitutes enables your practice to adequately cover for vacation times and acutely illness absences. Billing, coding, and electronic medical record technical issues are all addressed by experienced staff and information technology experts. Policies regarding patients’ rights and safety, billing and collection, medication refills and referrals, facility safety and maintenance, OSHA and JCAHO compliance, maintenance of various required certificates like CLIA and quality assurance programs are established and updated by appropriately designated personal. There is no burden on physicians with regards to these required administrative tasks.
So what is wrong with being employed by a hospital owned outpatient clinic?
Nothing in the first two years! Initially you are recruited to work with a very generous guaranteed salary for a 1-2 year term contract. However, this generous fixed salary is usually unattainable after 2 years when your salary will be based on a revenue production model.
After two (2) years, your income will be calculated by one of the available common methods such as Relative Value Units (RVU) ,WRVU or other formulas. No matter what method is used, your compensation is heavily dependent on the number of patients seen per day and the coding levels. Your compensation will be based on a percentage of your generated revenue minus the sum of variable and fixed core expenses. Variable expenses include all the costs incurred at the clinic site that you are working. Fixed core expenses (which are shared among all the clinics owned by the hospital) cover the salaries of the administration, financial, and human resources department.
In some formulas, the revenue from labs and x-rays done at your site are not credited to you because hospital owned clinics like to allocate those revenues to the hospital lab and radiology department! Without the revenues from these ancillary services you have to see many more patients to generate a salary comparable to your salary in the first two years. Stiff and restrictive covenant clauses in your employment contract prohibit you to work within thirty (30) miles of your clinic site or any other facility owned by the hospital! That may restrict you from working in a large territory should you decide to leave your job after two years. Recent court cases suggest a trend of less enforcement of that restriction, but many physicians will choose to stay despite lesser compensation after the first two years.

Physician's work has a value but providing a compassionate care for our patients must have a value also. Unfortunately, that compassionate care is compromised by the unreasonable financial expectations and overbooked schedules created for hospital employed physicians.

In comparison, the physicians at Community Health Centers are enabled to provide an optimum patient care, while enjoying a healthy compensation and a balance in life. Community health centers are the ideal medical practice to promote prevention as well as patient education. If you are exhausted by robotic practice of rapid diagnosis and treatment to meet the quota, and seek to have more of a chance to practice prevention and education, then check out employment opportunities with community health centers.

Tri-Area Community Health Center at Floyd

Why I left Private practice

You will probably care for the same mix of patients within a given area. Intrinsically, caring for patients is rewarding regardless of practice settings. However, there is a vast difference in your own quality of life when you are employed in a community health care center in comparison to working in a private practice. Despite the misconception, this dramatic improvement in quality and balance of life is achieved without sacrificing your annual income.
I spent 6 years too long in a private practice to realize that the only way to manage the ever rising overhead costs of practice operation is to see more patients per day and in a faster stressful pace. Overhead costs include your rent or mortgage, property tax, business and malpractice insurances, EMR and information technology expenses, employees salary and payroll taxes, health and disability insurances, staff retirement contributions, billing and accounting expenses, collection costs, licenses and CME fees, utility costs, ground maintenance and cleaning expenses, contract labor to cover employees vacation times, and finally vaccine, drugs and lab supply expenses. In terms of total costs, it is not unusual to incur a 300-350 k dollar expenses for a physician with full time employee ratio of 1:4 in a private practice. That means you have to see at least 15-20 patients per day just to break even with the costs (depending on your coding habits and the collection ratio the number may vary a little). Because of the smaller group, most likely the negotiated reimbursement is lower from insurance companies to the private practitioners. Can you imagine the extra unpaid hours you will spend to mange the administrative aspect of all those tasks? In addition, add to that the unpaid hours that you spend for your much needed vacation and CME times while the fixed costs of practice continues even in your absence. As a result, most private practitioners are overworked and forced to see 35 or more patients per day to manage expenses and generate the desired income.
So you ask why I left private practice.
Community health centers allow you to focus only on patient care by managing away disruptive administration tasks, covering your overhead expenses and paying you a salary comparable to that of private practice.

Tune in to my next blog to see the comparison between community health centers and hospital owned clinics.

Sam Saadat, M.D.

Dr. Saadat's Pediatric care

Dollars & Sense: Happiness & Balance in life,
Why not both!!!!



Since graduating from my family medicine residency program, I have worked in many different medical settings. I spent 4 years as an employed staff physician for 2 different hospital owned outpatient clinics. Next, I set up my own LLC providing house-calls and boat-calls at the lake community while keeping busy other times moonlighting in the nearby urgent cares. In search of a better lifestyle and perhaps a more lucrative practice, I obtained proper certificates and training to be able to provide care in cosmetic medicine, laser photo-rejuvenation and laser varicose vein treatments. After one year of cosmetic medicine, I realized how much I missed clinical care for patients of all ages with their variety of problems. I did not want to go back to being employed by hospitals so I decided to join a private practice. The next 6 years, I provided ambulatory, preventative and urgent care with another physician in a private office setting. As family physicians, we are trained to provide professional and compassionate care for our patients regardless of what setting our practice happen to fall under. We do our best for our patients whether we are employed by a big organization or in a small private rural office practice. We do our best regardless, and in many cases our best comes with a sacrifice of time away from our own personal life. Less than a year ago, I left the private practice to join Tri-Area Community Health Center in Floyd Virginia where I found the most ideal practice setting. Working at a Community Health Center is very satisfying professionally, fairly lucrative financially, and guarantees to balance your life ideally.
Stay tuned with my future blogs as I breakdown the details of different medical settings.....

Welcome Dr. Sam Saadat - Our April Ambassador

Dr. Sam Saadat has found joy in clinical practice again. His work in community health at Tri-Area Health Clinic in Floyd has set aside the disillusionment he felt in hospital-based and private practice environments. “It doesn’t feel like work here; it’s something I look forward to,” says Dr. Saadat.

Dr. Saadat was unsatisfied with various aspects of his previous practice experiences – the small amount of time he was able to spend with patients, the over-abundance of hours he worked, and the duties that were all too often not focused on medical issues, but rather on administrative functions. He had become so disillusioned he considered getting out of medical practice altogether. But working in a Community Health Center (CHC) has been “a godsend.” He was attracted by the mission and overall goals of community health work, but didn’t realize what that would translate to in terms of personal rewards. He is now able to spend 20 minutes on most patient encounters, sees a good mix of patient ages and clinical issues, doesn’t have to deal with the administrative or billing aspects of the clinic, and overall feels less burdened which affords more concentration on actual patient care.

He finds there is “less stress on the physicians, universally” of all of those that he has met working in community health. “Everyone enjoys their work.” He finds he can do more for patients in a community health environment than in a private practice – “there is better focus on the clinical aspects, better attention to detail” and he is “able to provide superior patient care.”

A WVU School of Medicine grad, Dr. Saadat spent twelve years in hospital-based and private practices. He felt his work/life sense of balance was out of whack. Now he finds that the healthier equilibrium with his time has improved not only his personal life but his professional life as well. He’s “sharper now on clinical issues, and keeping up with journals as they come in.” He has already finished his CME requirements way in advance. And his “wife is happy, the yard work is done, the house is in order.” He plays table tennis competitively and has had time to practice. Dr. Saadat says with pride that the “team took first place in Roanoke” recently.

When asked what how he would sum up his experience working in a community health center, Dr. Saadat says “It’s very rewarding,” and the “perfect place to practice.” To someone considering a practice opportunity in community health, Dr. Saadat says “Talk to me!”