Physician as Employee: Is This What I Signed Up For?

by Autumn Dawn Galbreath, MD, MBA
Today's Christian Doctor - Fall 2008

Healthcare has changed dramatically over the past fifty years. Theories abound as to the various causes and their effects - with managed care, the Generation X work ethic, and increased numbers of women in medicine being three commonly cited reasons for the decline of the traditional "family doc" who made house-calls and whose work hours were 24/7 as needed and the steep increase in the "physician shift worker" who figuratively clocks in and out and leaves his pager behind when he is off duty. Managed care brought financial pressures to bear on physicians in solo practice. Generation X brought a tide of newly graduated physicians whose definition of balance was quite different from that of their parents' generation. And the increase in women in medicine created job-sharing and part-time medical jobs, essentially for the first time in modern history. Be these changes good, bad, or some combination of the two, they have created a new paradigm in healthcare with which each physician must grapple as he evaluates his own practice structure and patterns. Like it or not, increasingly we physicians are becoming employees of large organizations like hospitals or multi-specialty practices. Many new medical school graduates proceed with a job search much like the one their non-medical friends pursue, expecting to ultimately be employees. And as financial pressures continue to squeeze some specialties to the breaking point, physicians who have been in traditional practice are closing their practices in favor of the safety net of employment and a guaranteed paycheck. What is the impact of employment on these physicians and their patients? How does life as an employed physician differ from life in private practice? What are the responsibilities unique to an employed physician? And how do you live out your faith-walk as a physician in the context of a large organization with rules that govern you and your practice?

It is critical for any physician who is considering employment, be he a new graduate or a long-standing physician in private practice, to fully understand what it means to be an employee. Most physicians graduate from medical school without ever having held a long-term job - we have just been too busy with our education. And the struggle is further pronounced among physicians transitioning to employment from private practice, as they are accustomed to being the owners and bosses of a small business. If we do not understand what it means to have a job, then we cannot successfully understand what it will mean to become an employed physician. I propose that understanding this issue is the single most important question facing a physician as he evaluates an employment opportunity. The best company in the entire world will not be a good working environment for him if he is unprepared for the realities of employment.

What are those realities? Employment has its benefits, of course. These are the aspects that I see most physicians focusing on as they consider employment versus private practice: You will receive a secure paycheck on a regular schedule. You will not need to make difficult decisions about staff management. You will not need to negotiate insurance contracts. You will be provided with training and resources related to business functions with which many private practice physicians struggle daily. You will have ensured vacation time, as well as coverage when you are away. You will no longer assume the full risk of your clinical practice.

On the other hand, with the reduced risk comes a reduced level of autonomy. Simply put, as an employee, many times you will have to defer to the well-being of an organization that is larger than you are. Decisions will not revolve around you. Policies will be made by those in leadership based on the overall good of the organization and its employees, and sometimes those decisions will be decisions that you do not like. Systems will be chosen that are the best fit for the most clinicians, but they will almost certainly not be the perfect fit for you. The good or bad behavior of other physicians in your organization will impact you - reputationally, psychologically, possibly financially - just as your behavior will impact them. You will not be an island. You will be one part of a complex landscape called a company. And you will have responsibility for doing your part toward its well-being.

By this, I do not mean that you are to simply "submit to authority." Of course, we should submit to those in authority over us because we are biblically commanded to do so. But I believe that it is only the beginning. Submission to authority for submission's sake - because it's the right thing to do - is dangerously close to being a hollow obedience. If we submit to the structure and rules of our organization simply because we must, then I believe that we are not living as the employees that God calls us to be. If we, as physicians, accept the benefits of employment and spend the paycheck we are given every month, but refuse to comply with the organization's policies regarding productivity, treating patients only within the confines of the prescribed clinic area, not exposing the organization to malpractice suits with unorthodox treatments, etc., then we are fundamentally abusing the employment opportunity that has been offered us. Did Jesus say "Give to Caesar what is Caesar's - but do it grudgingly and see if you can ever find a time to get away without it?" No. He instructed us to fully and willingly participate in the system under which we work and live.

Does this mean that we will always agree with that system, or that we should do things that we believe to be morally wrong because they have been prescribed by someone in authority? Of course not. But that is not typically the case for us. Should a Christian physician find himself an employee in an organization that suddenly begins requiring him to perform abortions, certainly he should place God's law above the rules of his company and he should appropriately and respectfully register his unwillingness to violate God's law on behalf of the company. On the other hand, should his company forbid posting of Scripture passages on the walls of exam rooms, he is not being forced to violate God's law. He may be frustrated, and he may well be in an employment situation that he can no longer tolerate. But I believe that the godly answer is an appropriate and professional departure from the organization, rather than a conscious violation of the organization's policies.

As Christian employees, we should be committed to the health and well-being of the organizations that employ us. We should cheerfully participate in activities that further the interests of the organization, assuming that those activities are not morally wrong or harmful to others. In so doing, we will shine as the light of Christ within our organizations. Having been an employed physician for my entire career, I can say that, while employment is not perfect and is not for everyone, employment affords a unique ministry opportunity for the Christian physician. Similar to other Christian physicians, an employed physician can minister to patients on a daily basis. But he has the additional opportunity, and, I believe, obligation, to minister to those in his organization, both by words and by deeds, including investing himself for the benefit of the organization that gives him the privilege of working there.


Autumn Dawn Eudaly Galbreath, MD, MBA is an internist in San Antonio, Texas, where she lives with her husband, David, and their three children. Though they met in medical school, David now owns a restaurant in the San Antonio area. Between the two of them, they have experienced multiple career transitions, and weathered the resultant stresses on their marriage and family. Autumn Dawn speaks to the issues of Christian marriage, being a working mother in the church, and being a woman in medicine with an engaging humor that brings perspective to these difficult issues.

Autumn Dawn earned her MD from the University of Texas Medical School at San Antonio, where she also completed her internal medicine residency. She earned her MBA from Auburn University in Auburn, Alabama.

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