There are a variety of practice options and structures available to pediatricians. Following is an overview of the various structures.
Federally Qualified Health Center||
Academic Health Center|
|More individual freedom||Less individual practice freedom||Not as much physician autonomy||Not as much physician autonomy||Not as much physician autonomy|
|Longer work hours - clinical and business||Shorter work hours||Work on a schedule||Work on a schedule||Work on a schedule|
|Complete responsiblity for the business||Less need to be involved in business aspects||Subject to employee constraints||Subject to employee constraints||Subject to employee constraints|
|High public/patient visibilitiy||Less personal visibility with public and patients||Marketing department||Marketing department||Marketing department|
|Extremes of financial return||Built-in-on-call coverage||Centralized patient record keeping||Centralized patient record keeping||Centralized patient record keeping|
|Business risk||Lower medicolegal/business risk||Low to no legal/business risk||Low to no legal/business risk||Low to no legal/business risk|
|Less opportunity for informal professional consultations||More opportunity for informal professional consultations||Required referral patterns||Required referral patterns||Required referral patterns|
|More limited working capital ||Access to larger amounts of working capital||Cost allocation to physicians||Limited due to federal funding regulations||Access to larger amounts of working capital; possible administrative limitations|
|Total involvement in business concerns||Less opportunity for involvement in business||System determined decisions||System determined decisions||System determined decisions|
|High-tech practice will depend on expenses||Greater chances to be involved in high-tech practice||Better access to equipment and better equipment||Better access to equipment and better equipment||Better access to equipment and better equipment|
|Set growth pattern||More limits on rapid income growth||Steady flow of income||Steady flow of income||Steady flow of income|
Solo practices are for pediatricians who want to own and manage their own practice. Solo practice physicians are responsible for all aspects of the practice, including establishing policies and guidelines, staffing, office hours, finances, and legal.
This type of practice may be as simple as 2 pediatricians sharing office space and staff, but operating as independent practices. This provides some relief from the financial burden of overhead and office operations and provides some relief from finding night-call coverage. Patients should be made well aware that the 2 physicians have separate practices. If there is no written agreement and patients assume that the physicians are partners, both physicians may be implicated in malpractice litigation.
A partnership is an association of 2 or more persons for the purpose of carrying on as co- owners of a business for profit. The partners in this arrangement invest together to make a profit. In this structure, each partner has equal rights, and also shares the risks and management responsibilities. New partners are usually brought in after acquiring the consent of all existing partners. Like marriages, there needs to be compatibility in medical practice and management philosophies among partners. Partners can also expect to receive a formal accounting of all partnership affairs. On the other hand, all partners may be liable for each individual partner’s wrong acts or acts of commission or omission assumed by the partnership as a whole, inviting individual liability for any legal action against the partnership. Also, in much the same way, partnership gains and losses are shared equally.
Single-specialty and Multi-specialty
Single-specialty groups pool the resources of several pediatricians. The legal arrangement becomes important and is essential to defining the roles and responsibilities of the partners. Multi-specialty groups provide a more diverse pool of medical and management skills, but with significantly less personal autonomy. Pediatricians joining new practices need to consider more than the business relationship to ensure that practice culture is a good fit for them. Differences in work styles, business philosophy, and professional relationships are not insignificant and may lead to problems impacting patient care. This is particularly true in small group practices.