On-Site Health Clinics Open Doors for Physicians

In the late 1990s, Walter Vieweg, DO, was running a solo family practice in a suburban setting outside Cleveland, Ohio. He provided healthcare for between 3,000 and 4,000 active patients. But something wasn't right.

“Contentment is natural wealth; luxury is artificial poverty.”

—Socrates

In the late 1990s, Walter Vieweg, DO, was running a solo family practice in a suburban setting outside Cleveland, Ohio. He provided healthcare for between 3,000 and 4,000 active patients. But something wasn’t right.

“I found myself having to work harder and harder to keep my income level where it was,” Dr. Vieweg recalls. “And the frustration of managed care was causing my blood pressure to rise. I was starting to develop hypertension, and I had missed every one of my daughter’s t-ball games. That was important to me.”

Dr. Vieweg needed a lifestyle change, and he found it by selling his medical practice and going to work for Whole Health, a leading provider of on-site health care services. It’s a trend being embraced by employers and physicians countrywide. According to the World Research Group, 30% of large companies—those with 2,000 or more employees—have health clinics for their workers either on-site or near the workplace. That number is expected to rise to 40% by the end of 2008.

Dispelling the MythsDr. Vieweg had often heard that physicians who join organizations like Whole Health have to give up a lot of their autonomy. It was an initial concern, but in retrospect, he believes that he really didn’t have much autonomy as a solo family practitioner.

“I had the responsibility for my staff, my rent, my accountant, my malpractice carrier … I was still answering to a lot of people,” Dr. Vieweg explains. “I don’t think that was too much to give up. And in terms of actually practicing as a physician, I now have a lot more time with my patients. I don’t have managed care dictating how many people I can see, and how quickly I have to see them.”

Dr. Vieweg has had a positive earnings experience as well since joining Whole Health. He explains that even in solo practice, his income fluctuated quite a bit. “[My income] was dependent on insurance. And with capitation, you could lose a whole group in one swoop and see your income dive. Having a steady income with little fluctuation is important.”

William Wanago, MD, chief medical officer for Comprehensive Health Services, a Virginia-based provider of on-site health centers, explains that what primary care physicians can earn in the corporate health arena is “reasonably competitive with what they may generate in terms of revenue in private practice. And if a doctor joins us on a full-time basis, they also receive a full benefits package, including paid vacation and holidays, and fairly regular hours—all of which count in terms of quality of life and economic aspects compared to private practice.”

Per-Diem DoctorsPatricia Hunt, DO, MHA, had a private internal medicine practice three blocks from the World Trade Center when the attacks of September 11, 2001 took place. In the aftermath, she found an increasing number of patients coming to her with issues that were not limited to internal medicine. Many were occupation related, prompting her to ask questions such as “How is this affecting your profession?” or “Do you need to change your work as a result of medical changes in your body?”

Three months after 9/11, Dr. Hunt closed her practice and eventually began doing per diem work for CHS. “I got involved in more practice opportunities where occupational health and internal medicine blended,” Dr. Hunt recalls. “I thought, this is where I want to be. I want to blend my years in internal medicine with how I can evaluate a patient properly in an occupational health setting.”

Dr. Hunt joined CHS, and today is the director of medical services at the New York Stock Exchange. She says the move has been rewarding both financially and professionally, but that even doctors who are looking for per diem work to replace or supplement earnings from a regular practice can have a positive experience.

“You can make a good wage as a per diem, and have your malpractice covered,” Dr. Hunt explains. “That’s two major reinforcements to your wallet. And many of the doctors who still work with me as per diems enjoy the scheduling flexibility.”

What’s the Lure?

Dr. Wanago explains that the frenetic practice in private medicine has, in many instances, overshadowed the quality of medicine being delivered. That element alone, he says, is pushing some doctors away from continuing in private practice.

“Knowing that you’re practicing evidence-based medicine with a heavy emphasis on prevention as well as intervention, those are the reasons why individuals go to medical school in the first place,” Dr. Wanago says.

Echoes Dr. Vieweg, “I think you have to realize how important it is to be truly autonomous. If it’s not all that important in the scheme of things, then it may be time to make a change. My only regret is that I should have done it sooner.”

Ed Rabinowitz is a veteran healthcare reporter and writer. He welcomes comments at edwardr@ptd.net.

71%—Percentage of Americans with access to an employer-sponsored health insurance plan.(US Labor Department, 2008)