Six years ago I left private practice and never looked back. I traded my autonomy for restful nights, a 401K plan (which I'd never had the money to fund), a regular paycheck (no more doing without at least once in January, February and March, and the disappearance of staffing issues. While I am occasionally frustrated by the "Dilbert" corporate environment, I work for a system that has a strong patient-centered mission and they have been reasonable and kind to me.
How did doctors get to this point? There are so many factors it becomes an interesting mind game to see if I can remember all the headaches that my partner and I wrestled with for the sixteen years we suffered through it. About six years into it we decided our theme song was Chumbawamba's "I get knocked down but I get up again..." It didn't help that we were both mothers with two young children when we started out. Neither of us were willing to sacrifice our time with our children so we refused to work eighty hours a week, thus our salaries looked more like teacher's pay BUT without the retirement benefits and summers off. Then there were the staffing issues. We always kept a key group of loyal individuals who worked for less than they could have, I suppose because they thought we were doing well by our patients. But there were always problems that made you want to tear your hair out--one employee was rude and chronically late, one did not want to work evenings (we were open two evenings a week), one had a child that was ALWAYS sick; there were raises deserved that we couldn't afford to pay, there were people who needed to be fired that we didn't know if our documentation was good enough. It never seemed to end.
Our out-sourced billing advisor also helped us with accounts payable and we got very good at creative bill paying. Of course our staff's paychecks came first and they never did without except for our nurse practitioner who allowed us to postpone her pay four or five times. We made that money up to her but my partner's and my pay was lost forever. Bonuses? Who are you kidding. We went to plenty of coding classes but had no clout with insurance companies to maximize our reimbursement. We did not see too many patients without insurance but those we did seemed to have problems paying our bills. We learned early on to collect co-pays at the window before being seen, or we might never see that money as well. These were the kinds of issues that keep you up at night. At the worst, when my business partner and I thought we were going to have to declare bankruptcy, I remember having what psychiatrists call EMA (Early Morning Awakening--a classic depression symptom). At 4:30 or 5 I would give up and go downstairs to meditate for thirty minutes to an hour trying not to think about telling my children that we were losing their home. Sigh--those were the days.
So now I am an employee in a big hospital-owned group. Just a little cog, but it is sooo much better for my patients. They get my full attention when I am in the room, my brain is never worrying about bills being paid, staff being disruptive or sleep being lost. When I go on vacation, I get paid and if I am sick then I am only worried about how to get well. No, I'm not always happy with how the administration does things and sometimes the corporate bureaucracy, legalese and slow-to-change atmosphere makes me crazy. But my life is much easier so I try to keep my complaints to a minimum--as I tell my daughters when dealing with husbands and children "Choose your battles. They aren't all worth fighting."