at one of the mini-Kaisers, which are separated by regional groups, but also has a national presence. It's a little different than most large groups because there's two arms to it. There's the clinical side, which is governed by physicians. And it's associated with its own health plan or HMO. I have no financial disclosures. So just a disclosure situation about what kind of job was right for me. I live in a very high cost of living city in a very high cost of living state. I'm married. I have three children. And so I work here. My patients, they live here. And I live sort of in the boonies up in the mountains where there's fire hazards all the time. So as mentioned briefly, so I'm going to go through this pretty fast, there's been a lot of expansion and regulatory pressures. So it has made your job search kind of much different than when some of us were looking for our initial jobs. But the nice thing is you have a lot more options these days. You have, it's not just an academic versus private situation. You have hybrid academic privates. You have privates. Kaiser has its own med school, for example. But also the point that was brought up earlier is who's owning this situation? Is it an employee model? And this has a lot to do with sort of autonomy kind of for your clinical day-to-day practice. There are also people who work as GI hospitalists and some people who do locums. So there's a lot of different opportunities out there that maybe weren't there 20, 30 years ago. And there's been a lot of consolidation going on, both between payers, so insurance companies and hospitals, also across industry. And we're facing, especially since COVID, labor shortages and a lot of increased costs. So the impact of COVID. So most people, most doctors, are now employed by hospitals or corporate entities. And this number has only gone up in the last three years, including during COVID. COVID, I think, has accelerated a lot of the changes for people in these small mom and pop type of small practices. And a lot of these groups have ended up joining larger practices. In fact, I think 70% of US physicians are now employed. There are benefits to this consolidation. You increase health care on some level is a business. So when you increase market share, you improve your bargaining power. You get better contracts with insurance companies. You have increased access to capital, which allows you to add new services and expand the business. And especially with EHR, this type of cost is not small. And so it's better to share these costs among more doctors. And you help increase purchasing power and negotiating. For example, an endoscopy equipment is cheaper when you buy in bulk volume, kind of like Costco. You have more ability to assume risk. And of course, you have branding and marketing opportunities in large groups that you don't have in a small mom and pop store, if you will. So you guys have to think about what you value. Is it time? Is it time with family? Is it money? And it's OK to value money, guys. Is it fame? Is it accolades? Do you want to be up on a podium? Do you want to be known for your research? What is it that you actually value? And that will really help guide your job search moving forward. So Dr. Adler had this study a few years back. What drives fellows to choose the type of job that they do? But if you look at people who choose academic versus non-academic practice, the first number one and two has to do with geography and whether or not you like your coworkers. Do you like your work family or not? And then if you look at the factors that drive fellows to choose what they want to do, those in academics, they love research. They love to teach. And what's interesting is here, if the salaries were equal, a lot of fellows would choose academic practice. If. If. So speaking of, time is money, as Benjamin Franklin once said, and sort of the value of time. Time is finite. It's relatively linear. I don't want to talk about physics right now, but in your case, it is linear. And most of us have about 4,000, maybe 5,000 weeks of life. So we spend the vast majority of our wait time at work in pursuit of education, career goals, and also in pursuit of money because it's valuable. It provides basic needs, food, shelter, the like. And for most people, a lot of economists have said, it tops out. Happiness tops out at about $500,000 a year. You can have different things you can buy with your money, but it's also helpful in terms of trading for time saving services and experiences. So this is kind of a little beam here. As we age, we have more money and time, but less energy. This is me. I'm in the thick of it right now. So what if you can have both? And you have time, some money. That's, I think, the best job. Whatever works for you in terms of your balance and how you want to spend it, and the goal is to be happy. So there are a lot of benefits to large group practice these days because they're so variable. I think you can, even in large group organizations, carve out the niche you want. There's people at Kaiser who do large scale research. Some people do a lot of teaching. So there's a lot of these hybrid type opportunities that are available in large group practice that aren't in traditional private practice models. So pros, resources to manage the administrative tasks of running a business. How many of you guys have a business degree after coming out of fellowship? Do you know how to run this business? And having a large group where you get to share this administration tasks among other people, you don't even have to think about it, it's not necessarily bad. You also spread the responsibility of clinical coverage across more people, so you're not at work all the time. If you own a business, you're at work all the time. For example, as mentioned earlier, if you own a restaurant and you're there, you're there all the time. You work weekends and it's your baby, right? So there's a little bit more opportunity, I think, for work-life balance in a larger group. And it also allows for, again, more robust opportunities for further education and training. There are a few cons. You don't get to make all the decisions, right? It's less, you have a lot of people. If it's a democratic voting process, it's a lot of people that you gotta take into consideration. There are certain scheduling and productivity expectations that are not necessarily under your control. There are certain policies that could be developed without your input. You have less clinical flexibility because a lot of times your referrals are capped to a certain extent. And if you are in an employed large organization, you generally have a financial ceiling. Again, large groups, sometimes the bureaucratic paperwork is not different than government jobs, if you will. So again, think about what you want. Where do you wanna live? Who do you wanna hang out with during your awake hours? Are you interested in more research and teaching opportunities than what's available? What type of patients do you wanna see? And how much control do you want over your day-to-day life and your daily practice? What do you wanna do with that kind of time? So Aristotle once said that knowing yourself, it's the beginning of all wisdom. But if you trace it back, his teacher is Plato, and Plato's teacher was Socrates. And it's okay if you actually end up changing your mind. It's okay to change your mind. 50% of fellows change jobs in the first three years. So sort of concluding, choosing the right balance of long-term sort of professional goals while accommodating what you want personally can be difficult. I think large group practices overall, they offer stability, relief from a lot of the startup business duties. It does have a built-in referral base and a lot of co-worker support. So you have to figure out what it is that you want and find the right fit. And if your needs change in three or four years, that's okay. There's a lot more sort of cross-movement among current fellows in terms of what kind of jobs that they want. So this is my work family. We send out holiday cards. That's the GI, endoscopy nurses and group. And this is my other family. So thanks so much. Thank you.

large group practice

physician

work-life balance

decision-making

clinical flexibility