For residents in their penultimate year of training and thinking ahead to job opportunities, group practice can be a curious option. While it is a type of physician private practice, it is distinct from the archetypal small, office-based practice in several ways.
For starters, a group practice has more than one physician owner—in fact, it may have dozens—so it may be single specialty or multispecialty. In addition, group practices are likelier to contract with major health systems, which adds another layer of complexity to clinical and business decision-making.
AMA member John R. Corker, MD, is an emergency physician with Emergency Medicine Specialists, an independent, democratically organize single-specialty group in and around Dayton, Ohio, which contracts exclusively with a health system in the Buckeye State. He’s very happy with his choice of the group practice setting and his particular practice, but he still wishes he knew more in residency about how to evaluate his options.
In an interview conducted at the 2024 AMA Interim Meeting, Dr. Corker discussed what he thinks every resident should know about life in group practice.
Step 1: They’re not all the same
Dr. Corker noted that his experience with group practice is limited to the independent, democratic variety, and there are many other types.
“There's also hospital employment, private equity-owned national staffing firms, locums opportunities,” he said. “Coming out of residency, in 2017, I was specifically looking to be an owner in my group, to have a say in decisions on how we practice medicine and how we contract and work with hospitals.”
For example, since Hurricane Helene knocked out a major IV fluid manufacturer, Dr. Corker has been involved in the problem-solving.
“I'm not just told how we're going to deal with that,” he said. “As an owner in independent, democratic group, I'm part of those committee meetings. I'm part of those conversations to be able to help clinically figure out how we are going to do this in a way that not only works financially, but also works for patients.”
The same goes for salary and benefit packages, including paid time off and parental leave.
“When you’re an employee, sometimes you're just stuck with whatever your employer offers. But as owners, we reevaluate compensation and benefits every year based upon market trends and how the group is doing,” he said, noting that this applies not just to the practice’s shareholders, but to its employees too.
You might have an ownership option
Coming out of residency, you will start off as an employee at a group practice, but you may be able to vest into ownership. The terms of this process can vary widely. Dr. Corker was eligible after 2,000 clinical hours worked.
“In my group practice, sometimes people can knock that out if they work a lot of overtime in the first year. Plus, there's a five-year vesting period for full ownership,” he said. “If you decide to apply for partnership or shareholder status and you are accepted and approved by the board and the shareholders, you immediately get a full vote.”
This means you are an owner and a shareholder from a decision-making standpoint and in terms of knowledge of the business.
“In addition, with our being an S corporation, if there are any profits leftover at the end of the year, those have to be distributed to the shareholders,” he said.
Think ahead about burnout
“We hear a lot about physician burnout and the threats to a long, satisfying career for doctors in all specialties, and everybody suffers from some level of burnout,” Dr. Corker said. “What I've come to realize seven years into practice—because I've been more intentional about thinking about it—is I think burnout really comes from a sense of loss of agency and loss of control over our own condition.”
That loss of agency can manifest in many ways.
“Is it the fact that you don't get to spend enough time with your family or explore hobbies?” he said. “Or is it because every time you go to work, you don't get to practice the way you were trained because you're being told specifically how you're allowed to practice medicine by nonphysicians or C-suite folks who aren't part of your department?”
For him, it was the latter.
“I've realized more with each passing year that I really did choose the right practice setting, in terms of an independent, physician-owned, democratic group. It allows me, at every turn, more agency and more control in how I'm allowed to practice medicine and how we deal with business negotiations roughly every 18 months because of rolling three-year contracts,” he said. “Seeing the big picture helps me treat patients more appropriately and incorporate resources that maybe I wouldn't have otherwise thought about.”
On the other hand, your key to work-life balance may be just ensuring you have adequate personal time. This might be as straightforward as needing to an hour a day to play with your dog or time every week to go for a hike.
“In that case, perhaps employed practice is the best way to go. There's nothing wrong with that, especially if it's going to allow you to continue serving patients for a long period of time, because ultimately, that’s what we need—doctors practicing bedside,” Dr. Corker said.
Know these questions to ask
When evaluating individual job opportunities, there several key topics to cover, Dr. Corker noted.
“You should feel empowered to know that when you go into interviews, you’re not the only one being interviewed. You are also an interviewer and the employer is an interviewee,” he said, noting that physicians hold a lot of power because employers need physicians.
“First and foremost, I would ask how the group structurally promotes and values physician satisfaction and longevity,” he said.
The answer should show that the practice is thinking beyond the day to day and has an actual plan.
“The second question is, as things change, how will I be involved in decision-making?” he said. “For example, as we encounter obstacles like drug shortages, how will I be involved in strategies to mitigate them? And as revenue streams evolve, how will I be involved in understanding their dynamics and trying to maximize benefits?”
The third question should address how the success of the business will influence your personal success.
“Outside of the salary, how am I taken care of from a retirement perspective? That should be part of the evaluation of the job,” Dr. Corker said. “What kind of profit-sharing or 401(k) contribution is available? How much paid sick leave is there, if any?”
Also, physicians finishing residency typically are young and of childbearing age.
“Not everybody wants children, but if that is something you want, you should ask about maternity or paternity leave too,” he said.
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Must-haves in a contract
Once you get a job offer from a group practice, there are several things you should make sure are addressed in your contract, Dr. Corker noted.
“There has to be language in there—and I can't stress this enough—regarding due process if you are accused of any sort of wrongdoing,” he said. “It could be medical malpractice. It could be harassment. Whatever the case may be, what is your due process as an employee if you are accused in any way of wrongdoing? If there's no language about due process, that is a major red flag.”
Another is medical liability insurance, which needs to include a very important term.
“A lot of physicians are sued at some point in their career,” Dr. Corker said. “It's not unlikely, let's put it that way.”
In fact, a recent AMA analysis found that nearly one-third of physicians had been sued at some point in their careers.
In many cases, that has happened after the physician left the practice where the event occurred. For this reason, your medical liability insurance has to include “tail,” which covers you for medical liability claims after you’ve moved on to another employer or switched coverage.
“Say something happens in 2025 and you change jobs for whatever reason in 2027. You will have new malpractice insurance in your new job. And then in 2028, you find out there is a lawsuit over something that happened in 2016. Your current malpractice insurance will not cover you for that. It's important that you know upfront that your malpractice insurance from 2016 had tail,” he said. “That’s very important.”
Finally, your contract should include transparency in how the revenue stream goes from patient-care documentation to your getting paid.
“It's not as simple as it sounds,” Dr. Corker said. “There’s a lot of machination that goes on between those two. It should shed some light on how much skin you have in the game.”
Still, you shouldn’t expect this, or many other terms in an employment contract, to be negotiable.
“When it comes to employment contracts, we talk about negotiating a lot. But if you're in a group setting, outside of an independent physician doing locum tenens or otherwise working on their own, typically those are very standard contracts. It's just a matter of choosing which group’s standard contract works best for you,” he said.
Where to look for job opportunities
There is a time in your second year of residency when you start to feel more comfortable clinically. Then you begin thinking about getting a job someday.
“The best advice I've ever gotten about jobs was from individuals whom I trusted and had relationships with,” Dr. Corker said.
This makes seeking out relationships with mentors—not just within your program but also nationally—so important.
“You'll learn about the pros and cons of different practice settings from the most reliable sources: people who you trust,” he said. “Honestly, when I was looking at jobs, most of the opportunities that I really wanted after looking into them were communicated to me personally. I didn't get them from a job post. Most of the best jobs are not posted on any public forums.”
One of the best ways to create these new relationships, Dr. Corker said, is to go to a meeting of the AMA, your specialty society, your state medical association or your county medical society, where you will meet doctors who can share their personal experiences in finding the right fit.
“I haven’t run into even one who wouldn't shoot me straight about what to look out for, how practices in these various settings really work,” he said. “They can also help you find that intersection of your needs and a practice’s needs so you can experience professional satisfaction and combat burnout long term.”
