IMP opportunities available?

[Guest guest]

Is anyone aware of an established IMP-style practice that might be looking to add an internist?(recently completed residency, currently licensed in PA; prefer East coast for proximity to family--twin daughters on the way!-- but would consider other locales for the right opportunity.)advTHANKSance,Ken

The hallmarks of "IMP" are practice redesign with low overhead and superb access so as to allow longer more robust visits that can attend to patients needs/patietn centered carehow easily can you negotiate overhead- who owns what percent of paper towels/ nurse/ time / room /space etc?

I f you can know that and cover your costs then do you want to be paid just for what you see OR expect a salary?Who pays for your nurse? receptionist? What are the mechanics of how it coud work? Who wil cover for you?

What is the advantage to the hospital to do this with you?The folks in Washington State Group Health divested themselves of the hospital piece and made longer vvisits and little consistent teamlets I think and reduced er use /increased continuity and improved various metrics they measured.

It is a big conversation for an employe r to have and if you are the only one doing this how can that work? Someone near here was told lots of verbal support to try this- couldnot work it out... The whole culture of the palce has to change, but let us know!

My hospital (Eisenhower Medical Center in Rancho Mirage) started a subsidized pseudo-imp practice about 2 years ago to try and recruit primary care docs into the area and at least for the time being the practice is holding together - the docs that work for the hospital only see 10-12 patients per day and the hospital is able to bill more because of "facility charges" and such. I am not sure of physician salaries but I think they are quite competitive. They also have a "boutique" style option where they charge an annual fee for additional personal service.

However, it remains to be seen how long this situation will last. I think the contracts were written for 2 year terms so many doctors are in the process of renegotiating as we speak. There have already been a number of doctors that have left the hospital so it is not a perfect system.

I have not been tempted to join because I am doing great in my independent IMP practice. Also, my hospital does not have a good track record in terms of valuing physicians or making a commitment to physician's professional development. They also have a history of dropping support for pet programs all of a sudden once the original idea has lost luster or they move on to the "next big thing" (or the donors who are subsidizing the program cut back on their giving).

I hope to make it to IMP camp this year if possible - I have been very busy with the practice and I also have been giving a lot of lectures and traveling around a bunch lately.

Good luck! Just keep in mind that in the current medical marketplace, hospitals have a very different agenda than primary care physicians (almost 180-degree opposite goals in many cases). ER and specialty coverage, keeping beds filled (but only for as long as utilization review deems appropriate!), care of uninsured and medically-indigent patients, admitting for surgical specialists (even when not appropriate), complying with regulations and JCAHO requirements, and keeping VIP or politically-connected patients happy - these are the primary goals of hospital administrators. Very often I feel all the hospital really wants is my medical license and malpractice liability coverage so they can fill holes in their medical services or administrative programs - they don't necessarily value or develop any loyalty to individual physicians.

, MD

Palm Desert, California

OK, so if any of you remember any of my previous posts, I have seen the light, want to be IMP. I have a sticky contract holding me hostage due to student loan obligation. I can terminate with six months notice but I have too much debt to foot the bill currently to make the leap (on the hook for $125K give or take in addition to what my start up would be).

I have approached management and have expressed my concerns repeatedly with biweekly meetings for going on 7 or 8 months now. I finally said I've had it and I plan on leaving (gave notice without a date, no formal written notice yet as I wanted to see how they would handle my student loans, which they still haven't answered me on). The CEO says to me that I haven't told him what my issues are and given him an opportunity to fix it (HA! Were you not listening the last 8 months?!?) I proceeded to provide him with 15+ articles (much of them written by you fine folks) as obviously what I have

said verbally hasn't registered detailing exactly what I want. I have had it repeatedly told to me in varying ways that I will not survive without them, I don't know what I would be getting into, and I haven't considered the ramifications therefore, I should just stay put. (Despite the fact that I have been extensively reading this listserve, joined IMPcenter.org and have listed to the calls, read the articles, consulted with some of you personally by email, have consulted a lawyer, and accountant, and a business advisor and have met personally with the IMP closest to me geographically--and I am coming to camp ). I might be young and inexperienced, but I am not naive or stupid--I know it will be hard but at least I would be off the hamster wheel and be happy (right? lol) and feel like I have purpose again.

Here's the thing--they want the opportunity to try to make an IMP practice work within our employed group. I would be separated out

(or so I would demand) but still under the hospital as a separate clinic. Is anyone out there doing this currently? Does anyone think it can work? I obviously have my reservations. I kind of feel like they are humoring me so they can later try to say "I told you so". What should I look out for? Thoughts?

Thanks!Crystal in TN

-- Pratt

-- MD ph fax