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.