While searching for the first job right out of residency new doctors are often focused on money and location. The student debt has to get paid down somehow. This is also the first time in a decade a new doctor may have a choice where they live without entering a wish list into a computer system. Money, location, and schedule is important. However, the size of the group is also an important factor.
Joining an independent or smaller group can have several benefits. I joined a small group and have found out that it was a blessing that I didn’t even take into account when I was searching for a job.
Have a say in what happens
Being in a small group can allow your voice to be heard. It’s much better to be in a meeting where you can do the talking instead of being talked to the whole time. In my group my voice was listened to from the beginning. The new hire and I brought up a suggestion for the schedule chance and a month later it was voted on by the 20 members of the group and enacted. Good luck making that happen in a very large group.
Large organizations tend to take on bloatware as the lifespan of the group goes on. Over time, these quality measures, projects, or rules trickle down to the physician. This leads to more paperwork, meetings, or emails that are very low yield. With a smaller group there is less likely to be online video training sessions, mandatory meetings, power point presentations, and poor use of your time.
Bargaining power with your contract
Small groups want to keep good employees. It costs money and time to have a high employee turn over. A small group will most likely be more willing to accommodate your needs when signing a contract. Large corporations or multi-state groups often have a take it or leave it type of contract.
Chance to advance in the company
The smaller the company there may be more of an opportunity to advance into another type of role within the same company. Putting an MBA to use may be easier in a small group where they may be in need of those services. Small groups often have physicians doing dual roles which also means more money.
The group starts to feel like a family
The smaller the group the more you will get to know each one of your partners. I joined a small group and within a month I was being invited to my partners houses for BBQ and beers. We also call each other all the time asking to cover shifts when important things come up. It makes each of us want to do an excellent job and no one dumps work on one another.
Chance of financial hardship
Small groups may not have the financial cushion to absorb a one time write off. Buying a CT scanner or expanding to a new urgent care center may be a one time expense that could bankrupt the company. Before jointing a small group ensure that the company seems to be in good financial health.
Less bargaining power with insurance companies
The larger the company, the more likely insurance companies are going to be willing to do deals. A group of 3 doctors will not have the same bargaining powering with insurance companies of a group that has 1000 doctors. This could mean that a small group may have to limit what insurances they accept. In turn this may limit patient population seen.
One bad apple can spoil the bunch
In a small group, one misbehaving doctor or unprofessional doctor can spell disaster for the group. When I joined our group there was one person who would call in sick quite often. He would not call the night before or give any warning. Sometimes it would be at 9am letting us know that he would not be there that day. This meant that we either had to beg someone to come in and cover or spread the work among the group. Its much more of a burden when there are fewer doctors to spread the work among.
Lack of a buffer
Larger groups can absorb a surge of work. For example, the flu season has started at the hospital I work at. Our average daily admission rate has doubled to tripped in the past two weeks. In a small group it may be more difficult to have back up for when surges in work happen. Consider this when choosing your job. If there are 4 doctors who rotate weekend call, what happens when one or two of them can not take call in a particular month? That burden falls on the remaining doctors in the group.
Overall I am happy that I joined an independent smaller group. In my first two months of being with the group, many of my suggestions have made their way into being implemented with the company. The members of the group that I work with have also been there for an average of about 5-6 years. Since being a hospitalist is a relatively new job, I think the longevity goes to show that people enjoy being with the group. Being in a small group for me has been a blessing in disguise since many of the drawbacks do not bother me. What do you think? Do you have any suggestions to add to the list?