Practicing private cardiology today for early career cardiologists

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Until I entered private practice eight and a half years ago, I didn’t realize there were so many different practice settings. There is no doubt that private practice itself has evolved since then. In 2007, 70% of cardiology practices were privately owned, while only 8% were hospital owned. This pattern has reversed in 2018, with 73 percent of U.S. cardiologists employed and 25 percent self-employed. Physicians entering private practice today have several options, each with their own benefits and drawbacks. Following is a list of common business models and points to consider:

Approximately 12 percent of cardiologists practice alone today. A major advantage is complete autonomy. However, there are several disadvantages, such as high overhead costs, limited scheduling flexibility, lack of resource support (IT, billing, staffing, etc.), increased call volume, and inability to subspecialize. Therefore, quality of life is significantly impacted. For more information, visit

A private group practice can be either single specialty or multi-specialty. Compensation is usually higher in single-specialty groups. Self-employed cardiologists earn roughly $80,000 more than their employed counterparts, according to Medical Group Management. Size matters in each type.

Larger group settings offer increased flexibility, lighter call coverage, easier subspecialization, and more financial stability. Cardiology groups today consist of fewer than ten doctors in 45 percent of cases. Twenty-four percent of groups have 11 to 25 doctors. Larger groups (more than 10) are more likely to suffer from less cohesiveness. It may also affect how one practices due to the size of the group. In smaller groups, every cardiologist must participate in most activities. One can subspecialize in an area of interest more easily in a large group.

There is a disadvantage to joining large multispecialty groups in terms of governance. There are times when primary care dominates the business structure of these groups. Specialty “pods” can be created to assist specialties like cardiology, which have unique practice and compensation models. By creating specialty pods, cardiologists are able to gain a greater sense of autonomy and also be involved in organizational governance. Leadership development can also be a good career path for cardiologists.

Practices owned by hospitals are often financially tied to the hospitals, which can be good or bad. Research suggests that this may also increase Private health insurance prices increase with physician employment, and physicians refer to hospitals regardless of quality or cost. Hospital-owned groups make five major mistakes, according to Beckers Hospital Review, including excluding physicians from quality, financial and physician advisory committees. It is important for physicians in these settings to be cautious about signing initial contracts versus renewal contracts that have fewer perks and more restrictive covenants. Additionally, cardiologists should be aware of billing changes and whether bonuses are based on productivity or value metrics.

An integrated health system is a network of organizations that provide health care to a population, which can either be independent or associated with a health care plan, such as Harvard Vanguard or Kaiser Permanente. According to the 2017 SK&A report, the largest U.S. integrated systems include:

  1. The Ascension Health System (St. Louis, MO)
  2. Franklin Health Systems (Franklin, TN)
  3. The Catholic Health Initiatives in Englewood, Colorado
  4. (Nashville, TN) Hospital Corporation of America

Some argue that the power of these networks lies in their scale – the larger, the better. Access to better technology, enhanced expertise, and capital is also theoretically advantageous. It is recommended that doctors joining these types of networks have an escape clause if the alliance is too restrictive or they are unhappy with their results.

As an early career cardiologist, you may have several options in private practice, each with its own advantages and disadvantages. The decision ultimately revolves around what model best fits your professional, financial, and personal needs.

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