Hospital based physicians work in various departments of the hospital or their practices may be owned by the hospital. Hospital-based physicians are traditionally those who provide what were once hospital-based services such as anesthesiology, radiology, and emergency medicine. Hospitalists - usually primary care physicians who specialize in inpatient care - also are hospital based. The hospital may also own a group practice in which the physicians are employees of the hospital.

Proximity to the hospital is one advantage of this type of setting, along with an established, ready patient base, a steady salary, the presence of many other types of physicians, and management support in the areas of billing, collections, contracting, etc. Autonomy can be somewhat limited in hospital settings and physicians may be called upon to help govern the hospital through committee work.

Specialty Hospitals are an emerging style of hospital based practice. Many of these hospitals, which generally focus on cardiology or orthopedic surgery, are owned or partly owned by physicians, and are devoted to a single type of specialty care.

HMOs

While several years ago it was thought that the staff model HMO might become more pervasive, this type of setting has remained somewhat regionalized on the East and West Coasts, and is generally diminishing in terms of number of opportunities available.

Physicians in this setting are paid by the HMOs as employees and may be bonused on production, utilization of resources, and patient satisfaction scores. HMO physicians provide care only to those who are enrolled in the HMO. Kaiser Permanente in California is an example of a staff model HMO which provides its physicians with a "patient panel" made up of enrollees. Often, there are practice protocols that are developed by the HMO which must be followed.

HMOs offer a more predictable lifestyle with set hours and usually the administrative side of medicine is less onerous as billing and regulatory issues are handled by the HMO.

LOCUM TENENS

Locum tenens physicians work on a temporary basis on assignments ranging from a few days to months. A complete discussion of locum tenens can be found at Working Locum Tenens.

Deciding on a new practice setting is difficult and new physicians don't always make the right choice. This is partly inevitable because, as a new physician, you may not be able to assess your need for autonomy, your ability to work with other physicians, your personal schedule and other factors until after you have experienced medical practice for yourself.

The key is to approach whatever setting you examine with a critical but open mind, so that you have the data you need to make an informed decision. Once you have done this, there comes a point where you simply have to "roll the dice." That's when it gets interesting.