From independent to employed: One allergist’s journey

July 24, 2017

Kira Geraci-Ciardullo, MD, FACAAI, a practicing allergist in New York, recently made a big move, and it’s one you may have thought about yourself. After 30 years in private practice, she became an employee of a hospital system. Dr. Geraci-Ciardullo graciously agreed to share her experience with College members and offered tips to those considering a similar change.

Many physicians are making a similar move. The Physicians Foundation 2016 Survey of America’s Physicians found that only 33% of physicians identified as independent practice owners or partners, down from 48% in 2012.

Dr. Geraci-Ciardullo enjoyed her years in private practice. She was her own boss, and as a young mom, she could create the flexibility she needed to balance her needs with those of her patients. “It was a tremendously valuable experience and provided great training in learning how to run a practice,” explained Dr. Geraci-Ciardullo. Over the years, however, declining reimbursements and insurance coverage, coupled with EHR expenses and increased competition from large specialty (ENT) groups, made her consider other options. When White Plains Hospital reached out to her last year, she was ready for a change.

Dr. Geraci-Ciardullo has several suggestions for allergists considering a similar move.

1. Understand your new role.

As an employee, you’re no longer calling all the shots; you need to go through the proper channels to get approval for things like supplies. In her new role, she needs to meet quality control measures and Joint Commission standards, as well as follow established safety protocols and coding standards. As the only allergist on staff, she’s also had to educate leadership about the specialty and required protocols. “When I have a suggestion on how to improve something, I gently make recommendations based on my experience, and have found this to be successful”, notes Dr. Geraci-Ciardullo.

2. Read your contract and negotiate.

Dr. Geraci-Ciardullo recommends working with an attorney to negotiate important points in your contract. (She found an attorney with physician contract expertise who offered her a discount through her state medical society). Consider your compensation formula, restrictive covenants and exit options. “Know your value, and make sure it’s a contract you can live with”, she advises.

3. Make sure the group is financially sound.

Whether you’re looking at joining a hospital system or another practice, make sure the group is strong financially.

If you’re thinking of joining a hospital group, here are some other things you might want to consider:

  1. Does your contract cover the cost of medical malpractice tail insurance?
  2. Will the hospital system take over your EHR or do they have their own? How will the transition of patient records be handled? Who will be responsible for maintaining existing patient records?
  3. Does your contract include reimbursement for CME?
  4. Hospital systems don’t usually take over accounts receivables from your previous practice, so you’ll need to budget six to eight months of staff time to close out your accounts.
  5. What financial and quality metrics will you be required to meet in your new employment contract? Are there RVU requirements, or must you work a certain number of hours/week or see a certain number of patients/day?
  6. Are there certain schedule requirements? What about working weekends, early mornings and evenings?
  7. What involvement will you have in practice management functions? Business decisions may be more centralized in a hospital system or large group practice, but there may be opportunities to provide input. Talk to others docs to find out.
  8. Know your value and what you can provide to the group. Do you serve a particular ethnic group in the community? Is your practice strategically located in an advantageous geographic area? Do you have a unique relationship with a payer?
  9. What is the plan for growth in the specialty of allergy/immunology? Is there any limitation on the types of patients seen by allergists (i.e. do pulmonary specialists see asthma patients or dermatologists see urticaria patients?)

There are both advantages and disadvantages to becoming hospital-employed. You won’t have to worry about the cost or maintenance of an EHR, government reporting requirements, and the day-to-day requirements of running a medical practice. On the other hand, you’re no longer in charge, and you may be judged by new metrics. RVUs, quality measures and patient satisfaction scores may all factor into your compensation. For Dr. Geraci-Ciardullo, it was the right move for this stage in her life.