Monday, April 18, 2005

Is Corporate Medicine For You?

Today we interviewed a PM&R doc for a job at the insurance company where I work. It made me think about some of the concerns I had about taking a non-traditional medical job.

Would I still be a "real doctor?" What would my peers think? Would I lose my skills? Would I get bored? Would people think I was an "insurance whore?"

What would doctors think when I called them to ask about their patients? Could I stay active clinically?

I have been very satisfied with the answers to these questions.

My colleagues are actually jealous. I have the luxury of a traditional work schedule without call, without the worry of malpractice, with a salary and no collection or billing worries, no patient complaints. I remember one medical conference where I was routinely surrounded during the breaks by docs asking about the opportunities in corporate medicine.

I get to participate in corporate bonus programs and an employee stock purchase plan.

I am an employee, which means I have a 401K, employer paid (or at least subsidized) medical, dental, vision, life and disability insurance programs and paid time off.

Think about it. Do you actually get 30 days of paid vacation per year. Along with 10 days of paid CME, a CME budget, license and professional membership fees paid?

I have the luxury of taking as much time as I need to review a claim file. I have access to a well stocked medical library as well as subscription web sites with continually updated medical resources. I feel my fund of knowledge is as good as it has ever been, even when I was a resident.

I am not sure I would be able to do this job if I didn't have the opportunity to stay active clinically. I work as a hospitalist and in the ER on a regular basis. Having this variety makes all of these jobs more tolerable.

I haven't found that anyone other than the plaintiff's lawyers think of me as an "insurance whore." When I call someone on the phone and describe what restrictions and limitations I think are reasonable, the usual response is something like, "Wow, that's pretty good." I have become the specialist in disability medicine. I enjoy calling the treating physicians associated with the claims and discussing the cases with them. The docs seems to value the information I can share with them.

I definitely haven't become bored. This has actually surprised me. This is what I was most concerned about. The files do have some repetition, but the presentation is extremely varied. I asked some of the other docs at the company today and they all felt the same.

I actually feel that the ER has greater potential for boredom than the insurance job. As you have experienced, either in the ER or the office, it becomes difficult to tell the difference between one and the next URI, diabetic, hypertensive patient.

One the orthopedists with whom I work remarked that he gets to see a greater variety of orthopedic cases than he did when he was in private practice. We see the most complicated cases in a great variety of settings.

Unfortunately, we also get to see some of the worst, most substandard care dispensed in this country.

I have more time to spend in consultation with the other docs at the company. I mentioned this during the interview today and got nods and comments of agreement from the other docs present. Even in a group practice, there is so much time pressure that we don't have the luxury of leisurely consults. I have learned a great deal from my interactions with the ortho, neurology and neurosurgery specialists with whom I have daily contact.

It's certainly not for everyone. I miss the ongoing patient relationships I had when I was in private practice, but I didn't have that in the ER anyway. Of course, a lot of physicians don't have that in their specialties. I guess that's the family practitioner coming out in me. I know that my family certainly benefits from the predictable schedule associated with this type of work.

This is not meant to be a recruitment monologue, just some of my thoughts. However, if you have questions or thoughts, put them in the comments or e-mail me.