Practice Transition: Private to Hospital-Based

As bills mounted and reimbursement diminished, Joseph M. Tibaldi, MD, and his partner considered closing their private practice-Queens Diabetes and Endocrinology in Queens, NY,-and joining a hospital-based practice. After two years of grappling with the decision, they decided to close their practice of 30 years when financial troubles became significant.

Choosing to sign on with New York Presbyterian Queens was an easy decision because Dr. Tibaldi, his partner, and the other three endocrinologists on his staff already worked there as voluntary attendings. “It was like a second home; I watched it grow over the years and knew everyone there,” says Dr. Tibaldi. “The biggest motivation was to get a steady paycheck.”

For hospitals, the incentive to acquire practices is to increase their patient referral base, Dr. Tibaldi says. “When a patient needs surgery, the hospital would anticipate that I would recommend having it performed there,” he says. “It’s more lucrative for hospitals to do surgery than general care.”

For endocrinologists who aren’t as fortunate to have such a connection, Dr. Tibaldi would advise them to speak with physicians who have already made the transition when considering joining a hospital-based practice. “Ask about a hospital’s good and bad points,” he says. “Have an attorney review the contract. And, make sure you have a good sense of trust about the new relationship before signing on.”

It took about three months for the partners to close their private practice, which is now three years ago. “When I told my patients that we were joining a hospital, none of them had any objections,” he says. “Most of my patients, many of which have seen me for several years, followed me to the new practice.” The hospital moved the practice to a smaller building, just 10 blocks away from the old one, and two miles from the hospital.

In order to make the transition, Dr. Tibaldi had to end his lease, pay the final bills, and sell the furniture and computers to the hospital. Records were transferred to the new practice. “The hospital adopted an electronic medical record system and patients’ paper records had to be typed into the system,” he says.

Although Dr. Tibaldi wanted to bring his entire staff to the new practice, the hospital’s policy required all staff to have a high school diploma. “We tried to circumvent that because a few administrative staff who worked for us for a long time didn’t meet the criteria, but it was a brick wall,” he says.

Dr. Tibaldi admits to losing a modest amount of autonomy as a result of joining the hospital practice, and having to deal with a lot of bureaucracy. “The hospital is run in a regimented way; you have to follow the chain of command and at times there are tremendous delays in getting things approved and fixed,” he says. “In private practice, when you want to do something, you do it.”

But along with the steady paycheck, Dr. Tibaldi appreciates getting paid vacation, sick time, and holidays, as well as paid time off to earn continuing education. “Although I have to count and allot my days, there is some flexibility,” he says. He also gets good medical and disability insurance, and there’s less administrative paperwork.

Dr. Tibaldi says he’s under no constraints to see a certain number of patients per day. That’s good, “because I’m accustomed to a certain workflow and I like to have time to talk to my patients,” he says. “Many of them are like friends because I’ve known them for so many years. But we do have to meet certain criteria every year in order to maintain our salaries.”

When all is said and done, reflecting upon the transition, Dr. Tibaldi is glad he made the change.