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Working at Kaiser Permanente as a Doctor

This is a rather simple article which I’ve been meaning to write for a few years. I left Kaiser Permanente in 2017 and it was a difficult decision at the time. I don’t have any regrets now. Here is my review of working at Kaiser Permanente as a doctor.

Starting at Kaiser Permanente

My journey at Kaiser began in 2009. It was the first job out of residency which I started in the San Diego region. I started out as an urgentologist and did some cross coverage in family medicine and pediatrics as well.

What was great about the experience is that I had a lot of support. Like most young attendings I was a little unsure of what to expect. I had access to many different doctors working next door whom I could hit up for info.

Also, at Kaiser Permanente, you can call up any specialist and ask them for advice as to what to do with a patient who is having breakthrough bleeding on hormones or worsening of their diabetic foot ulcer.

Growing at KP

Working at KP was generally fun for my personality type. I was efficient and had a good sense of humor. I made friends with fellow doctors and the PA’s and NP’s came to me with questions.

Most of the nurses were friendly but they were unionized and less worried about performance. This meant they weren’t too worried about getting fired for incompetence.

I eventually took some small leadership positions and after a few years at KP in San Diego I moved over to the Kaiser Permanente in Portland, Oregon to become a PIC – basically, a medical director.

After one year being a medical director, I became the assistant chief of the urgent care department. I tested out if I wanted to become a chief but realized it wasn’t for me. I was done with leadership work.

Dealing with Managmeent

It’s true, most people who go into leadership do it for the title and they have personalities to match. I am ashamed to say that in my leadership roles I didn’t always make the best decisions. I took the hammer approach and became a little too harsh.

I knew how to fake empathy which back then I thought was real empathy. But in the end, I alienated a lot of clinicians who could have used more support. This is likely how you might feel when dealing with management.

Working as a doctor at Kaiser Permanente you’ll experience the top-down approach. Decisions are made behind closed doors and slide down to you.

When talking to other physicians who had been at KP for a while, it was all about getting to the next year. Many were counting down the years they needed before vesting and being able to retire.

Though, when you look at the online reviews for being a doctor at KP it seems many were happy. Though some apparently were working in the TX KP which doesn’t exist and many are nurse anesthetists.

The Patient Population

KP bids for big contracts with unionized groups. Many individuals got their insurance through their employer. They didn’t pay for it and often placed exactly that much effort into their health.

I’m majorly generalizing, of course. I had wonderful patients whom I’d see in the urgent care regularly. Sadly, because they couldn’t get in with their PCP – the waits were too long.

There is no patient empowerment at KP. None. I didn’t even know about this phrase until I left the Kaiserverse. In fact, I think this is something valuable to add to your patient population when you’re such a behemoth of a medical group.

Moving Between Kaiser Groups

I had no trouble having my benefits transfer right over from my medical group at SCPMG to PNWMG. I picked up right where I left off.

I still had to put in 1 year before becoming a partner again but that didn’t deduct from my contributed years. My pension halted at that point but I picked up with a cash balance plan. No biggy.

The people at Kaiser PNW were really cool. I really enjoyed working with my new colleagues and felt that even the management was a little less burnt out and more engaging.

But I also was high up in the management. I suspect people treated me differently and I engaged with a different group. When talking to colleagues on the battlefield, seeing patients in the clinic, they expressed the same level of frustration and burnout.

Retirement and Benefits

I am convinced that most of us doctors stayed at KP because the potential of our future wealth was so high. The golden handcuffs, right?

You get disability, malpractice, health insurance, retirement benefits, and you vest in all these somewhere in the 5-10 year range.

Unfortunately, when I needed my malpractice insurance KP refused to pay for it. I had to deal with the state medical board and I knew I had coverage for this through my insurance. When my lawyer and I called up KP their attorneys said that it wasn’t in their best interest to cover me.

You can’t argue with that – if I had to pay out something for someone else I also wouldn’t think it’s in my best interest financially. But that’s sort of what you count on when you dedicate so many years to KP.

Work Opportunities at Kaiser

When I started at KP I was really in love with medicine. I had so many opportunities for picking up extra shifts.

I worked in the fast-track in the ER. I worked at employee health. I did the urgent care and primary care and I picked up shifts in pediatrics. It was wonderful.

I learned so much working at Kaiser. I wouldn’t say I learned a lot because the way medicine is practiced out in the community is very different. You don’t get to learn about all the specialty meds and unique surgeries and treatments.

But working at KP you can move into management, virtual medicine, and move into different departments. You can work part-time or full-time or pick up extra shifts.

Just don’t think anyone will let you go from full-time to part-time. No way. You’ll wait a few years until management will allow you to drop a part of your patient panel.

Working at Kaiser Permanente as a Doctor

In summary, the work was good. The support, very good. The experience overall made me feel like I was an unimportant member in the overall healthcare game.

Your schedule was up to someone else and things always came down from the higher-ups which changed your routine.

I loved the many different work opportunities I got but that was only because I’m pretty aggressive and reached out to so many different departments. My colleagues who tried the same got refused.

In the end, I worked 8 years at KP. I never vested in my pension because I couldn’t stay there for another 2 years. I have the personality type that I like to have consistency but also have options to work when I want and how I want.

The Right Fit

Working at KP you’ll be put into a small box but you’ll be given a lot of resources. The expectation from you isn’t high but all the little things you have to do add up and drain you by the end of the day.

The stability of the work and the benefits and of course the income is solid – you won’t complain. But you can earn far more being an independent contractor at KP while maintaining your freedom.

For someone who wants to really grow roots into one system and never think about another option, KP is really good. They try to deliver good healthcare and treat their doctors well.

If I were to design a system that treats a lot of people and has an overall good outcome, I’d build a KP. If I were to design a system that treated each patient and doctor fairly and to high standards, I’d create the opposite of KP.

My Career Path

I was on a path to get out of the medicine game early. I worked 40-50 hours a week and paid down my debt and saved and invested a lot.

By age 39 I had enough money to retire – that was one of the main reasons I stopped working at KP as a doctor. My investments earned me enough to sustain my lifestyle.

Later I got interested in healthcare consulting and some telemedicine. I have been doing a little bit of that here and there. My relationship with medicine has changed in a good way and I’m still figuring some things out.

19 replies on “Working at Kaiser Permanente as a Doctor”

Good stuff; its a new set of skills you need to develop to survive/thrive in corporate life. We’ve learned to jump through lots of hoops in college,med school, residency; its just a differnt set once you get out.

I think the biggest transition to corporate life is not learning incentives of people you work with can be different than yours; they aren’t bad just different;

Also it forced growth mechanism that helps not just in your work. I used to think training in med school and residency was the problem and in not teaching it; Not now. You have to learn through mistakes…Its the fee to get better. Same as getting better in investing.

Good points. One factor worth considering with the investing analogy is that I enjoy the process of investing. For the many years that my mistakes weren’t resulting in growth at least I still enjoyed what I learned and the process of making mistakes. In the www I found like-minded people who enjoyed investing the same way I did. My financial mistakes weren’t punished to a point of no return – I could make as big of a mistake as I was comfortable with and I was the last person to hold myself accountable.
Compare that to corporate medicine. The learning is there, the growth is there, but is it the style of growth and learning you want or could there be a better suited place for you?

” but is it the style of growth and learning you want or could there be a better suited place for you?”

Sounds like you’re saying “who we are is where we are, not what we are?” I agree a negative work environment leads to burnout; or a good one can be energizing; For me is meh. It’s a job. Punch in and out. I’ve tried 3 different job (1 solo and 2 corporate) and come to acceot 25% of any job sucks; just choose the job with the 25% you can put up with and maybe even be challenged and grow in.

For me, its nice to help out folks that want to be helped and those that dont, I dont push; I try a method or two to guage readiness and if not, I try to at least improve the scorecard numbers.

I tried but didnt enjoy administrative medicine even though its fewer patients. Too much travel and too much take home work.

I forgot to mention but obviously a lot of other variables like wife and kid’s wishes, commute time, athletic activities, friends also affects how we feel about a job.

Good read. Many points resonate with me about working at KP, but I am not in care delivery rather KPIT, which is worse. Fake empathy is rampant. I am one of the ones that have grown with the system. The years led into decade and a half. Although I do not believe I have made a big difference in this behemoth that seeks good outcome, but not great outcome. Thanks doc for the refreshing candidness, it helps to know what I suspect is not just me thinking it in silo.

In the end the work we do on a day to day basis has to mean something to us. At the lowest part of that pyramid is money and there is nothing wrong with that. But above that is my mental well-being. I know that KP is one of the better organizations for the delivery of clinical care. Far, far from perfect but so am I. The medical assistants and the IT people are indispensable because that’s where people end up for their care. That broken wrist or that stroke would otherwise cause massive complications down the road. But I’ve realized in myself that when I don’t like where I work or what I do on a day to day basis I come to resent even the care for those who genuinely have no other option that’s known to them.

Great read. I wish I read your column before joining Kaiser. I have a quick question to ask you. I hope you can give me an advice about it. I started working at Kaiser in the outpatient clinic in Southern California for the last 8 odd months. Prior to this I have worked for almost a decade as a Hospitalist. Currently, I don’t like working in the outpatient set up and want to transition to working in the in patient set up. However, the outpatient folks don’t want to let go of me and stopped this transition. So what would my options be. Will quitting my present position and applying for in patient set up at KP be the best option or would it negatively backfire on me

It depends on how your standing is in these 8 months. The inpatient group is different from the outpatient and neither will want to step on the other’s toes. Talking to your chief and letting them know that you’d like quit and perhaps switch to an outside company for inpatient work likely will move needle and unlikely leave them being too mad at you as long as you can do this respectfully and with some humility.

Great piece and very helpful. You said you didn’t wait 10 years until you were vested in your pension. Could you talk about your decision with this? I figured it makes sense to wait 10 years, then you at least get something for retirement – however, at 10 years it’s only 20% of your base pay (not actual pay). That’s also pre-tax and if you’re young you are looking at significant devaluation with inflation over the next 20-30 years by the time you retire. Am I correct with this?

While I wouldn’t look a gift horse in the mouth, this actual amount (if the pension exists in 30 years) is not that substantial. Not unless you stay until retirement. Let me know your thoughts, because I too am leaving KP. Thanks.

Valid points – I believe that the pension will still be there when I reach retirement age, had I decided to stay.
I’ve written other articles about the topic which I’ll link below.
The amount at the 10-year mark is something I can easily safe for myself working for far less. A pension isn’t some magical unicorn only accessible through KP – it’s essentially a payout over several decades much like an annuity.
The question for me was whether I was enjoying my work at KP enough, making enough of a difference, growing, feeling I was a valued employee, and whether I was financially secure if I were to continue working there for a full 10 years, or an extra 2 years in order to vest.
For me the answers didn’t make sense, I had enough money saved then, and have more than enough money saved now so the decision in hindsight makes sense. In 30 years my answer might change. But if in 30 years I’m regretting a decision that cost me at most $60k/yr in future dollars I would assume that I didn’t take advantage of all the options available to me.

After the death of a doctor who worked at Kaiser for 20 years, will his wife and children continue get health insurance?

So incredibly helpful!!

Thank you from a Pediatric PGY-2 who is about to embark on applying for that first post-residency job and feeling quite overwhelmed by all the complexities of this milestone!

Keep fighting the good fight– for our patients and for ourselves 🙂

Glad it is helpful.
As for that first job post residency, I think there are a lot of great places you can work for where you’ll learn from fellow physicians on staff. Having other specialists and fellow peds you can learn from is quite valuable.
I learned a lot at KP by also talking to the specialists but the downside of it is that you won’t learn how the real world works because KP is a closed loop system. Even if you may not earn a ton the first few years out of residency it’s worth it to work in a place where you’ll really master the peds clinical aspect and learn some good admin as well.

Could you give me your insights about transitioning from per diem to a part time hospitalist with Kaiser. Would the benefits be any different from a full time hospitalist. Will the time working as a part time hospitalist be counted towards pension

Any position labeled part-time will come with a proportional percentage of benefits based on 100% of full-time work.
80% or 8/10th gets 80% of the benefits of a full-time employee and accumulates vacation and vesting and pension at that ratio.
Same for 70, 60, and 50%.

Thanks for clarifying. The part time position that is being offered to me is making me work on a full time schedule as the full timers. Would my full time schedule not make my benefits similar to what the full time people get. I know that I will not be getting the educational time off for this position but am I not going to have comparable benefits with everything else except for the pension

Your based will be part-time and if you work your base, that’s what you’ll accrue.
If you work a full-time schedule long enough then you’ll accrue benefits based on the full-time schedule.

Do part time KP physicians receive health insurance coverage or do they have to pay for it? For example, working 0.5 FTE. I understand for vacation/pension/etc it’s a proportion but what about health/vision/dental?

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