Career Choices Outside the Ivory Tower: Private Not-For-Profit Health Care Systems

Abigail Simmons, MD, FACC

When I decided to pursue advanced training in adult congenital heart disease (ACHD), I assumed I would spend my career in academia. As I searched for my first job, however, I discovered the unique opportunity that practicing within a private not-for-profit health system has for advanced subspecialists. I knew that as an early career ACHD physician, I wanted to have a strong clinical practice and the opportunity to bring my subspecialty to an underserved area. As I explored positions both within academia and the private not-for-profit sector, I found that the latter more closely aligned with my career goals. I selected a position within Presbyterian Medical Group in Albuquerque, NM. Since starting my practice with Presbyterian, I have found that my subspecialty practice is similar to what it was in academia (in terms of patient complexity, management options, etc.), but the administrative and clinical environment is much different. I also found that there is an increasing community of cardiologists with advanced training (i.e., advanced heart failure, pulmonary hypertension, advanced cardiac imaging, etc.) who are developing programs outside of academic settings.

In order to better articulate how private not-for-profit health care systems view and develop advanced subspecialty practices, I interviewed Jeff Kinney, director of practice and operations for Presbyterian Medical Group's Heart and Vascular Care in New Mexico about the role of subspecialists within private not-for-profit health care systems.

1. Are private not-for-profit institutions interested in developing subspecialty practices within cardiology (i.e., advanced heart failure, cardio-oncology, cardiac imaging, ACHD, etc.)?

Yes, absolutely. Patient care and experience are typically the number one priorities of any health care system. When looking at patient experience and the care continuum, hospitals and health care systems focus on providing a "one stop shop" for their patients. At Presbyterian, patients often request more appointment slots, as well as more clinicians in specific subspecialties so they can avoid having to go to different institutions for care.

A private not-for-profit would add a subspecialty based on patient care needs. For example, adult congenital cardiology may not have enough demand to validate 100% of the clinician's time focused on that patient population. However, if the physician is integrated into a pediatric cardiology group or an adult cardiology group, and some of their time is dedicated to general pediatric or adult cardiology, then that helps to validate the addition of the subspecialty, as they are benefiting a larger patient population.

2. Are there particular benefits to working at a private not-for-profit institution?

The benefits to working at a private not-for-profit institution include more direct patient care, cross care continuum collaboration and connection to organizational mission.

Traditionally, and in my experience, a clinician employed at a private not-for profit institution will see more patients per day. For example, in cardiology a clinician may see up to 20 or more patients per day on average. In addition, the higher direct care volume can have a direct favorable correlation to compensation for the clinician.

In addition to the higher patient care demand, the clinician at a private not-for-profit will likely be integrated into other supporting clinical areas via patient consults/referrals or on a panel with clinicians from other specialties for multidisciplinary patient care conferences (such as a multidisciplinary clinic for patients who require the input of other subspecialists such as heart failure, interventional cardiology, EP and cardiac surgery). This allows the clinician to be a strong link in the patient care chain.

In addition, clinicians may feel more personally connected to the particular mission and history of a not-for-profit health care organization.

For a clinician deciding between joining an academic or not-for-profit organization, it is important to decide where your passion lies. If your focus is research, in addition to direct patient care, then an academic institution is probably a great place for you. If you are less interested in research and more focused on direct patient care, then a private not-for-profit might be a better fit.

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Abigail Simmons, MD, FACC

This article was authored by Abigail Simmons, MD, FACC.