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Practice Options And Leadership

Hardly Working For A Large Medical Group vs Working Hard For A Small Medical Practice

Larger organizations function by having defined roles with division of labor. There are specific positions and each position has a list of tasks and responsibilities. Individuals are hired into these positions sometimes based on seniority and other times based on competency. Bureaucracy is heavy in larger organizations and advancement is based on nepotism or ass-kissing. Competency and being highly effective/efficient isn’t well tolerated because it means that those above and below this person will have to put in more work.

So how do large companies survive? All they have to do is sell more goods and services than the little guys. In the US quantity is much more valued by the average consumer than quality. The general public puts in far more resources into consuming entertainment than researching the consequences of their actions.

In contrast, the smaller companies have a stricter hierarchy without defined roles. There is a lot more plasticity and the main goal isn’t to keep your current position and title but to do the best you can for the company. You don’t answer to your supervisor, instead your performance is measured and if you can’t cut it you are let go. There are hardly any corporate ladder-climbers in these smaller companies and there is generally a lot more work integrity.

There are many exceptions but I am generally talking about successful companies, whether large or small. Larger companies pay higher salaries with better benefits and deal with unions to make management easier. Smaller companies deal on a more individual level which creates more accountability.

I work in a large company. I don’t work for a large company. I use this distinction because I just need to keep myself out of the lowest percentile of incompetency. I can make up for any inadequacy by kissing ass or doing favors for my superiors (picking up extra shifts, volunteering for a project, taking on leadership roles).

In a small company my performance as a physician is measured by patient satisfaction and usually appropriate care. This isn’t in comparison to my peers but based on evidence-based medical practice standards.

I could start stepping over the incompetent nurses and clinicians and make patient care a priority… I could refuse to provide ‘customer service’ and instead make patient care a priority… I could go in a little earlier and leave a little later and call back patients and follow-up with those patients who may fall through the cracks … I could take more intensive training courses to constantly improve my clinical practice.

I could do all the above and I will still get paid the same as the incompetent clinician working next to me. All the while because of my higher competence I will have higher responsibility, I will have to see the sicker patients and expose myself to higher stress levels, higher liability and a shittier work-life balance.

Instead, being the clever person I am, I could just ride the wave one step above the sea of incompetents beneath me. I will then be eligible for advancement and leadership roles because I’m not rocking the boat, instead I’m standing out. An advancement comes with less clinical responsibility and a higher pay.

Alternatively, I could work for a small practice, where I would be doing a lot more work but be able to provider much better patient care. This work would come with higher professional satisfaction, more labor, less free time and a lower salary.


Which practice setting would you choose?


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