Practice ​Types

Overview

​John V. Hartline, MD, FAAP

​​As discussed in the section on historical perspectives, neonatology originated as an intensive care focused subspecialty of pediatrics directed toward the care of sick and/or very premature infants and toward related clinical and bench research. Within 10 years of the first NPM Sub-board examination, many neonatologists had migrated out of traditional university-based practices toward community hospitals and private subspecialty practice. The purpose of this section is to overview the practice activities and time distributions of individuals self-describing their practices types as academic, private, academic/private, or hospital-based (employed). No individual practice will exactly match any of these aggregate examples, but hopefully these descriptions will give you a better appreciation of the variability now existing within neonatal practices. There is no "right" or optimal pattern—what is right for you is what works for you. In your Career Planning Personal Workbook you created a pie diagram of your idealized practice. This pattern will not tell you what practice type is for you; it tells you what you should seek in practice responsibilities over time regardless of the underlying practice structure you join.

Surveys of neonatologists in established practices have been quite consistent showing about 1/3 in academic practices and 2/3 distributed among private, private/academic, or hospital-based practices.

These data were obtained from a web-based survey of neonatologists done by the Perinatal Section's Committee on Practice Management (2004 CPM), from registrants at NeoPrep (Acad/Pvt was not an option for them), from registrants at the Scottsdale Perinatal Workshops (Workshop), and from workforce data from the Committee on the Fetus and Newborn (COFN).

Surveys of neonatologists also indicate a nearly-uniform satisfaction with the decision to become a physician and with the selection of neonatology. This high degree of satisfaction is reported from all varieties of practice. Achieving satisfaction for yourself likely will be achieved by melding a thorough understanding of yourself [see "Personal Career Planning Workbook"] with the spectrum of practice types and activities. The following discussion will depict patterns reported by individuals who self-describe their practice types. Remember, within each type there is large variability and these examples are to give you a basis for analysis and for questions.

Academic Neonatology

Academic neonatal practices may have the greatest variety of practice opportunities, especially because academic faculties have expanded the opportunities in the clinical tracks and are exploring scholarship in the arenas of application, integration, administration, and education in addition to the traditional discovery-focused research. Academic faculty positions by their nature will require clinical care and teaching, with added scholarly activity in one's area(s) of academic interest. Tenure and/or continued affiliation rest on achievement of mutually derived academic goals.

Time distribution from an aggregate of academic practices is illustrated below. Clinical care (C) demands the pleurality of total faculty time, and combined with education (E), most of which is oversight and mentoring of trainees in nursery settings, consumes most workforce effort. Added clinical demands for newborn care have led to increasing interest in clinical track development in academic environments. These data were secured from physicians well-established in practice, many of whom have directorship roles in the nursery or university, as is reflected in the administration (A) component of the time distribution and whose scholarly research (S) has matured. Academic practice is heterogeneous overall, and but individuals' patterns vary greatly.

When surveyed as to the time (per average week over a one year's period) required to be "in-house," whether in the nursery, office, lab, or clinic, academic neonatologists' median response was around 60 hours per week. Academic neonatologists surveyed estimated that subsidies for research provide about 13% of their total practice income as compared to the 26% of total time spent on research.​

Academic Private Mix

Neonatologists describing their practices as Academic/Private constitute about 20% of those surveyed, when that option is included. The time distribution shows a shift toward more clinical (C) responsibilities and less scholarly time (S). As expected from a group in well-established practices (most >15 years beyond fellowship), many had assumed administrative (A) roles in their hospitals. Time commitment to teaching is similar to the academic colleagues. Even more individual variability is noted in academic/private patterns than is seen in academic practice, because scholarly endeavors are more of an elective nature and issues such as tenure and academic rank, although existing, are not as forceful.

The median time "in-house" trended slightly lower, but many reported >80 hours per week of total time commited to the practice (in house plus on call). Although research consumed considerable time for these physicians, subsidy for research provided about 1% of total practice income, with many practices reporting no economic support for research.

Private Practice

About 2/3 of those surveyed report their practice type as private. This group is very heterogeneous, and includes neonatologists in locally-owned practices and those employed by large national groups, such as Pediatrix Medical Group.

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As expected, private practices in neonatology have a wider range of practice size and acuity of patients, ranging from large community hospitals with comprehensive services similar to many universities to smaller units with low volume and lower acuity. When interviewing for positions in private practice, exploring the practice size and patient mix is key. Clinical care is reported to be a much higher user of time, with much less time allocated to research or teaching. One-half of the physicians in private practices report spending 50 or more hours per week "in-house" and many report having total (in-house plus on call) commitment exceeding 80 or even 100 hours per week. Almost all of the practice income is derived from individual patient billings, with only small subsidies for administration (director's fees).

Hospital Based

Hospital-employed positions in neonatology have increased somewhat in the past three to five years, now comprising up to 20% of neonatologists in recent surveys. Although the number of reports is small, hospital based practices are largely clinical ( C ), and may require more time commitment to administration (A) than seen in private practices. Some time is spent on education (E) ; a bit less is directed toward scholarly (S) or research. Practice income is the through salary negotiated from the employer, although for some there is opportunity for sharing of proceeds from billings. As this segment of neonatology is still small and variable, applicants need to explore the practice details thoroughly, as they may not be at all similar to these aggregate data.

Other Practice Patterns

Locum tenans. Practices of all types may encounter an acute shortage in the workforce in association with unforeseen illness, injury, or other misfortunes. For those individuals so inclined, temporary staffing may be of interest. No data are available as to the number of our colleagues in locum tenans arrangements.

What's for You?

Most important for your career development is to find a practice site that is the best first step toward your long-term ideals. With the incredible diversity among all types of practice, only by comparing and contrasting your plans with the range of possibilities available in the context of the practice's workforce needs will you be able to discern if a fit is found. The decision is a big one; take the time, ask the questions, and know thyself!​​​​​

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