Should You Join An HMO Practice?

Plenty of my friends from medical training have gone the way of the HMO (health maintenance organization), particular those who are working in California (read: KPMG). HMO’s were formed as a way to streamline healthcare costs whereby the healthcare system and the insurer are either the same organization or a closely knit partnership. It is sort of a top-down one stop approach to healthcare (a la Super Walmart). Presumably all specialists are available within the organization to consult and provide efficient healthcare.

Sounds like an ideal system, right? You really have to know what you’re getting yourself into.

HMOs provide a platform to jump start your career

After you become a newly anointed physician, patients still don’t know that you exist. In order to build your patient population you have to establish relationships with referring doctors and your presence in the community. However, in HMO’s the referral network has already been established. The patient volume seen by HMO doctors during their first year of employment are as high as those doctors who have been working for a decade in a metropolitan city!  This immediate volume is beneficial in that it provides a platform for instant experience. Not only that, many treatment protocols are typically in place to treat certain diseases. These “flowcharts” help ease your daily routine of medical practice.

Because you’re instantaneously busy in an HMO practice, you are generating revenue for the practice. They can afford to pay a decent salary. Since these entities are generally well-established, they also will likely have good pension, retirement plans, medical and dental insurance coverage (in their network!).

Despite advantages, practicing at an HMO isn’t a panacea

HMO practice isn’t suited for everyone. Because so many protocols are in place, it may feel like you’re practicing cookie-cutter medicine. If you need to offer treatment that is off-protocol, you might be out of luck. Then again, if you are in the private world, the patient’s insurance company may not cover off-protocol/non-standard treatments anyway.

The generous salary and benefits in HMO practices often translates into more rigidity in the daily schedule. If you need to take a Friday afternoon off for errands, you might have to use a vacation day. Need extra time off? It’s not a easy as shutting down the office for a day. Everything has to be run through the administration. The doctor, while she may be a shareholder of HMO, still functions as an employee in the system. In a way, you really aren’t the owner or controller of your medical career.

In light of a decent salary, you probably could make a whole lot more money if you saw a similar volume of patients and worked for yourself. There is no free lunch in the world, and if you are paid handsomely that means you are unlikely sitting around blogging during work hours.

Only You Will Know If You Are Suited For an HMO

HMO practices definitely offer a stable job for doctors at the expense of control of your schedule. As a summary, the pros and cons are as follows:

Pros of an HMO Practice
Instant patient volume
Well-established practice patterns and protocols
Good benefits
Less pressure to distinguish yourself

Cons of an HMO Practice
Less flexibility to innovate
Less flexibility on scheduling
Career success dependent upon system

 

What are your opinions on HMO practices?

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