Types of Practice

Author Credentials 

Paul C. Frake, MD
Park Nicollet Health Services
Maple Grove, MN

Module Learning Objectives 

After completing this module, physician should be able to:

  1. Discuss the basic structure of various types of otolaryngology practice.
  2. Describe how to apply this information to your individual situation and determine which types of practice are most compatible with your skills, personality, and career goals.
Module Overview
  1. Otolaryngologists may practice in the following settings:
    • Academic faculty
    • Academic affiliated private practice
    • Integrated health system
      • Typically, multispecialty physician group or hospital system
    • “Private practice” / small business
      • Can range from solo provider to large group of otolaryngologists
    • Military
  2. The following employment structures may all be applied to any of the above listed practice settings:
    • Employed - salary
    • Employed - hybrid of salary and production
    • Employed - production only
    • Private practice - production only, investing partner in the group’s business
    • Contract - variety of “non-traditional” arrangements including outreach, telemedicine, locum tenens, & temporary positions
  3. Within each employment structure, the following income sources may exist:
    • Active income
      • Income generated by actual work or direct patient care provided by the physician
        • Based on per capita patient care
        • Based on percentage of total billable RVUs or dollars
        • Based on “work RVUs” (wRVU)
    • Incentive income
      • Bonuses and other income provided by a larger organization for meeting pre-defined metrics (such as patient satisfaction, access, outcomes)
    • Passive income
      • Business investments in a group or other entity (such as a surgery center), where you receive payment based on the health and productivity of the invested organization, not from direct work
    • Benefits
      • Various items such as health insurance coverage, malpractice coverage, retirement plans, reimbursement for business expenses and CME, and many others
Review Questions
  1. You are an aspiring young resident who greatly enjoys research.  You want this to be a significant part of your career.  Which practice settings would allow you the time and resources to accomplish this goal?
  2. You enjoy teaching residents and students but want to live near family in the suburban/rural area an hour or two outside of the nearest major metropolitan city.  Which practice type would allow for this?
  3. You are motivated to grow your practice and manage the details of its functionality.  In which practice types will these motivations be valued the most?  Are there practice types where these aspirations may be harder to apply?
  4. You are interested in stability of income and less interested in business items outside of patient care.  What practices would this best apply to?
  5. You are transitioning from one geographic location to another, but there are limitations on the number of positions for an otolaryngologist in your new area.  Are there options available to you to generate income until your ideal job opens up?  What might those options include?
Resources
  1. Differentiating among medical practice settings. New England Journal of Medicine, Career Center. Published online on October 13, 2011. 
  2. ACS Practice Management Online Course.
  3. AMA Steps Forward
Resources 

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  1. Annual Meeting Webcast (AMW):