For 11 years, Hassan Alissa, MD, a San Marcos rheumatologist, worked for a hospital nonprofit health corporation (NPHC). During that time, he built a robust patient base and learned the ins and outs of the business of medi- cine. He also discovered that working for an institution owned by a large corporation has its limits. Last year, Dr. Alissa made a critical decision that would drastically affect his professional career. Armed with experi- ence and a devoted flock of patients, he entered the realm of solo medical practice in early January.
“I’m very excited about having my own practice. I envision having more freedom. Also, I grew weary of having to jump through a series of bureaucratic hoops every time I needed something,” he said. Dr. Alissa worked for Central Texas Medical Center, owned by Adventist Health System, from 2009 to 2012, and cared for about 150 patients a week. He worked for two other hospital NPHCs before that. Dr. Alissa describes the staff and adminis- tration at Central Texas Medical Center as “supportive,” adding that he exited the institution on good terms. Dr. Alissa is part of a trend in practice setting preference
that began in the early 1980s. While some physicians choose to start out practicing with established medical groups or hospital NPHCs, they may not remain there as employees. Preliminary results from the 2012 Texas Medical Association Physician Survey indicate a majority of physicians eventually become full or part owners of a medical practice. The survey shows that 78 percent of Texas physicians are full or part owners of their main practices, although 29 per- cent started practice as an employee. Forty-eight percent of employed physicians subsequently bought into practice owner- ship. Of the employed physicians who later became practice owners, 80 percent are still full or part owners of their main practice. The survey shows the majority of employed physi- cians (60 percent) work for other physicians. During the 2011 legislative session, TMA supported bills
that preserved a physician’s independent medical judgment in an employed hospital setting and that provided protections for
16 TEXAS MEDICINE February 2013
the thousands of physicians employed by hospital-run NPHCs. TMA supports proper and structured physician employment ar- rangements designed to protect the clinical autonomy of physi- cians — employed and independent — through medical staff oversight. The association has gone to great lengths to protect the patient-physician relationship as pressure mounts to allow hospitals to directly employ physicians and will continue to do so during this year’s legislative session. The association also has products and tools to help physicians make informed career decisions. (See “Employment Resources,” page 20.) Dr. Alissa says working for a hospital NPHC has pros and cons, and he has advice for physicians who are weighing their career options.
“Physicians should read their employment contracts care- fully and consider consulting an attorney to help with negotia- tions before signing,” he said.
Do your homework When Dr. Alissa’s contract expired last year, he consulted San
Antonio attorney Mike Kreager, who represents physicians and health care entities, for help negotiating a new agreement. During the process, Dr. Alissa says he realized it would be best for him to open his own practice. “For me, working for a hospital was a good way to get start- ed in medical practice, but I reached a point where I felt I could no longer grow my practice,” he said. Dr. Alissa’s employment contract had a noncompete clause that specified he couldn’t practice within 25 miles of Central
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