Job Responsibilities
I have day to day management in primary care of over 4000
patients from all ethnic groups. That includes seeing 22-24
appointments per day, fielding upwards of 40 phone messages per
day, answering upwards of 40 e-mail messages daily from
patients, senior management, care management, pharmacists, and
other colleagues. It includes new visits, physical examinations,
followup visits, chronic illness management, minor surgery,
laboratory and imaging study results followup, and referrals to
subspecialities with review of subspecialist recommendations. It
includes accepting the responsibiltiy for acute injury and
emergency that happens to walk in or be carried in the door.
In additon, I have responsibility to mentor a Nurse
Practitioner, teach first and third year medical students their
clinical skills, and teach Masters program Nurse Practitioner
students for their entire final clinical year.
The work week usually runs from 6:45am to 6pm daily, and twice
per months the clinc is open till 7pm requiring attendance till
around 8:30 or 9pm depending on the acuity of the care. Each
month I am required also to work in the after hours Urgent Care
for minor emergencies 4 hours twice per month. Each member of
this group is also encouraged to participate in the
administration of the group by attending administrative meetings
mandated by law. This includes such things as Infection
control, laboratory management, Patient safety, Medical Records,
Education, and Physician career development. Each week there
are clinical education sessions during the lunch hour, and we
are required to attend at least half of these sessions. There
is a lunchtime staff meeting once per week, and a team meeting
and an adminstrative meeting once per month also. Normally that
adds up to meetings during the lunch hour on 4 out of every 5
work days. The usualy physican legal, moral, and ethical
requirements are also part of the responsibilities.
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Job Requirements
In order to become a physican working for Kaiser you must have
graduated from an accredited Medical School, Achieved medical
license, and passed the Medical Boards in your speciality.
Board certification in your speciality is an absolute
requirement for hiring. Once you have been working for three
years with the partnership, the partners are able to evaluate
your work and vote whether or not to permit you to become a
partner. Partnership has its advantages in the corporation.
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Uppers
There are very many parts to the job that are good:
The hours are predictable.
The vacation is earned, and, if properly scheduled, will not be interrrupted
The pay is good.
There is no overnight call.
There is no mandatory hospital duty.
There are no mandatory OB cases.
There is no requirement to carry a beeper or cell phone.
You are never called into the hospital after hours.
You are never called at home.
The specialist and subspecialist backup is extensive.
There are no restrictions on ordering investigations.
There are no pre-qualifications needed to be met to allow patients access to
needed care.
There is no office management to arrange.
You do not have to hire or fire nurses or office staff.
There is no medical malpractice insurance to buy or arrange.
The legal system is all handled by the legal department.
You have 25 days of vacation per year.
There is one half day of Continuing Medical Education per week.
There are 8 days of Education leave allowed every year.
There are 22 sick days allowed every year, to include days for dental work,
physical exams, and any other medical condition thought necessary for your
health.
If you are gone on vacation, your pay does not quit, and your work does not pile
up, as colleagues pick up the slack while you are away.
The system is moving toward 1:1 staffing with one nurse for each doctor in the
clinic.
A computerized medical record is being rolled out, and will be in place within
the next 12 months. This will cost about 1.7 billion dollars, and will be
supported at least till 2011 to the tune of 1.2 billion dollars per year for
information systems support.
We do not have to buy our own equipment.
Clinics are completely staffed, and supplies are arranged.
The only thing doctors have to do is practice medicine.
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Downers
The work is sometimes hard and the demands on time are great.
All appointments are 20 minutes, but booked at 15 minute
intervals, which can be stressful for some physicians who cannot
get themselves organized. All physicians have the patients that
are considered to be the Albatross around their necks, but for
the most part, physicians see their own patients about 80% of
the time. Typical frustrations of the job are not related to
the system, but to the poor state of the health care provisions
and requirements of the law in the USA today. The fact that
state laws are made that affect patient health and do not have
any scientific basis or benefit to the patients is the most
frustrating of all.
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Lifestyle
The lifestyle is good for someone who wants to consider the job of physician as
a profession. There are those among us who can only be described as "hobby
doctors" who do not put in a full day's work, have poor work ethics, and only
work 80% of the time. It is frustrating to work with them, but that type of
person can be found in any job, medical or otherwise. It is disappointing that
the unprofessional conduct and work ethics has penetrated even this profession.
That said, the lifestyle is good. When I go home, I am home, and do not get
bothered. In the past decade I have not been called by a patient or the hospital
at home. My patients consider me to be part of their family, and often invite me
to family functions, school events, etc. I receive cards and letters from them
when they travel, and they are concerned about my health also.
I am able to participate in community activites. I have been active in my
church as a member of the church board for many years. I have helped start a
preschool that now is doing well.
The company was able to secure financing for my home, and, with the help of the
regional medical director, a suitable home mortgage was found that could be
managed.
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Compensation
Compensation variew with subspecialty, depending on market
values of the specialist in question. In general, Kaiser pays
about 15% higher than the current local market. Starting
doctors may expect to be paid well over $120K to start in
primary care, with very much higher starts in the superspecialty
departments, such as neurosurgery or cardiothoracic surgery.
Those areas also are competitive, as Kaiser wants to keep the
top surgeons working, and does not want to lose them to private
practice. Presently the pay is good enough that physicians are
not leaving to enter private practice because they would
actually take a cut in pay to do so. Family Practice and
Internal Medicine primary care providers with more than 10 years
of experience can expect around $200K per year, with full
benefits package. Benefits include full family health care,
Keohg, and TSR retirement plans, Common retirement plan, Long
term medical care insurance, dental insurance, and some of the
bulk purchasing discounts offered to large corporations. They
also participate in end of year distributions. If there is a
surplus of cash at the end of the year, negotiations take place
and the excess income is distributed among the partners. This
may range from as little as $1000 per year to as much as $16,000
per year. There are annual cost of living adjustments to the
pay, and also additional adjustments for successfully achieving
the clinical strategic goals of the group. This also results in
increased payments that may total upwards of $12,000 per year.
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Advice to Jobseekers
Get a good medical education. Become Board certified in your
speciality. Expect to work hard. Expect the work to be
rewarding. Expect the compenstation to reflect the hard work.
Understand that the USA has an unlimited appetite for healthcare.
Realize that the Kaiser model of healthcare delivery is likely
to be the standard by which all others are judged. Remember
where you heard it first!
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