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Pros and cons of clinical practice.

Pros and Cons of Clinical Practice

Every physician considering a career change away from clinical practice has to consider the advantages and disadvantages of continuing to practice medicine. The new setting or organization may make the decision for som physicians. It may require some element of practice, or the position may demand full-time attention to management matters. If you are truly planning your career, you should assess this issue before you look at specific opportunities. You will then know which opportunities to look at, and you will be making this decision for yourself.

We have found that the same issues come up in the seminars we have held for physicians interested in career changes each time we talk about the pros and cons of continuing to practice while managing. Here is what physicians tell us:


* Credibility. A quick way to establish your credibility is to see patients. Practicing physicians want you to be as good as or better than they are if you are to be their manager. By practicing alongside them, you learn what it is like to practice in the community and the organization. You will be better able to "speak the language" of the professionals you are managing. If you are in a highly public and visible position, the patients will also see you as a "real doctor."

* A Hedge. Practicing medicine is insurance against future uncertainty. You maintain your skills, so that if circumstances require it, you can always move back to full-time practice without a lot of relearning. It helps you keep your options open and gives you the chance to retain a familiar identity.

* Satisfaction. Practicing medicine provides lots of strokes. You receive positive feedback from patients that, in most cases, is more immediate than would be found in a management situation. The challenges of practice are intellectually stimulating, especially if you teach students or peers about your specialty. Practicing medicine helps you balance the needs of the organization and the needs of the patients. By keeping your hands in pateint care, you are better able to be sensitive to the special clinical issues that arise in the management of medicine. Practice is fun and gratifying.

* Money. If the organization allows it, you can retain the money your practice generates. In some groups, that is money over and above your salary as an administrator. As with the hedge, it's a safety net that guarantees some extra income.


* Conflict. Continuing to practice delays making a real decision about a career change. It weakens your commitment to management, heightens the tensions caused by role conflicts, and dilutes your focus on management. The uncertainty of making a full-time commitment to management is tough to handle. It's a whole lot "easier" to keep your practice going so that you can put off addressing the real issue of why you are even attempting to pursue both career at the same time. Of course, this tension does not affect just you. You miserable in your uncertainty; and so is everyone around you.

* Time. Managing your time is difficult enough in one role, nearly impossible in two. Two responsibilities lead to long days and interrupted evenings and weekends, which then lead to fatigue and reduced alertness on the job. Eventually the stress of trying to manage both jobs leads to burnout. As hard as it is to be current in medicine on a full-time basis, it is doubly so when medicine is a part-time commitment.

* Money. For many physicians in the higher income specialties, cutting back on a full-time practice to become a part-time physician executive means reduced income. An orthopedic surgeon working at full speed might earn several hundred thousand dollars. Reducing practice to take on management responsibilities will probably result in a substantial loss of earnings.

Your income can also be affected in another, less obvious way. Your role in management may make it difficult for colleagues to continue to refer patients to you. That relationship may become a conflict if you chair a quality assurance committee that reviews the care provided by those colleagues.

* Credibility. Moving away from full-time practice, no matter how slightly, begins to remove you from being "one of the guys." The loss of being a member of a group can be difficult to accept. A physician's credibility and stature in the community is measured by his or her doing "doctor" things.

Evaluating the advantages and disadvantages of continuing to practice medicine while in a management role is necessary to know which positions to pursue. By weighing the pros and cons and deciding their relative importance, you will be better able to choose the right opportunity.

Jennifer Grebenschikoff is Vice President of the Physician Executive Management Center, Tampa, Fla., a national recruitment and counseling firm.
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Title Annotation:Career Development
Author:Grebenschikoff, Jennifer
Publication:Physician Executive
Date:Jul 1, 1990
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