Scope of Practice

In general, there are three main physician practice opportunities for cardiologists: academic medicine, hybrid academic and private practice. Physicians in a hybrid practice model typically retain an academic appointment with a medical school or training program but have a limited role in trainee education and clinical research. Their clinical practice is in the community setting as opposed to a tertiary academic hospital.

The Case for a Hybrid Practice

As an early career professional, my experiences as an interventional cardiology attending physician at Vanderbilt University Medical Center (VUMC) in a hybrid practice model will be discussed. I have clinical privileges at a smaller community hospital, Maury Regional Medical Center, as well as VUMC. Since there is limited time for me to perform high-risk interventional procedures at VUMC, my primary practice is at the smaller community hospital. The clinical practice functions as an independent subsidiary of VUMC and provides cardiology services for this separate hospital. The hybrid model has been an excellent opportunity for me as an early career professional. I have thrived in this clinical setting and it allows for better work-life balance as a newly practicing cardiologist. It also provides an excellent venue to maintain an academic mindset, while allowing for the clinical volume of a private practice model.

Pros of Hybrid Practice

A hybrid practice model is an excellent career choice for cardiologists directly out of fellowship. Since it is normally linked with an established medical school or residency/fellowship training program, it allows newly practicing cardiologists to start their clinical duties without having to market oneself. In addition, the hybrid model might offer better clinical hours and call schedule than private practice due to a built-in network of support.

Hybrid practice models tend to have more physicians than a private practice, thus creating strength in numbers. A larger practice will have more leverage when negotiating with insurance companies as it is far more difficult to negotiate with seven cardiologists opposed to one or two. Being affiliated with a larger institution also allows access to more resources such as better electronic medical records, new technology, and educational resource access like the medical library and free CME. This access has allowed me to become more involved both nationally and locally. Having colleagues from all over who can mentor me is pivotal to my career growth. Being involved nationally within the ACC allows me to lecture at meetings, proctor cases and develop research protocols, as well as provides me with the potential for publications that I may not get from working in a private practice setting.

Cons of Hybrid Practice

Hybrid practice models also have several challenges to consider. Limitation in your access to procedures is one of the biggest drawbacks of the hybrid practice model.

Another challenge of the hybrid practice model is outside management. It is difficult to watch non-clinically trained managers apply business tactics to patient care. Many managers do not understand the clinical side of practice and it can sometimes be frustrating. Being managed by a larger institution also limits change – it is much more difficult to implement change within a medical center opposed to a private practice group.

Lastly, the hybrid model may hinder your chance for professional growth vs. a truly academic job. Since you are primarily doing clinical work and not a full-time professor, there is not as much time for trainee education and research. Unfortunately, as a non-tenured faculty, you are often subjected to the same rules and regulations as tenured faculty.

Overview and Review

I strongly believe the hybrid clinician model is the practice of the future. As of late, academic centers are becoming less financially stable and private practice models are less interested in the maintenance and paperwork of a clinical practice. The hybrid clinical practice allows a new opportunity for many clinicians to "meet in the middle." While I think most enjoy teaching and clinical research, I would argue all enjoy providing patient care more. This model can pave the way to deliver effective patient care in a modern health care setting.

This article was authored by Amit N. Keswani, MD, FACC, assistant professor of medicine at Vanderbilt University in Nashville, TN.