Job pairing: A Physician and a ?
July 28, 2013 10:09 AM   Subscribe

I am about to enter medical school. My partner works in an entirely unrelated field, but doesn't plan to stay in that field. It recently occurred to us that (with appropriate training) he could switch to a job in healthcare that would enable us to work together after I finish my residency and begin my practice. We are trying to come up with an exhaustive list of jobs that exist in the office of a primary care physician in private practice. Can you help us flesh it out? The things we've thought of so far are nurse, nurse practitioner, billing and coding, office manager, bookkeeper. Please point out if you know of someone who does this job in the same office as their partner/spouse.
posted by anonymous to Work & Money (29 answers total) 2 users marked this as a favorite
Lots of doctors have spouses who work as the office manager/accountant/bookkeeper for the practice. It's not uncommon at all.
posted by deanc at 10:19 AM on July 28, 2013 [2 favorites]

My primary care provider has his wife as office manager/biller/person-of-all-work. They have done this for decades. It works for them, well enough, because she is personally motivated to get the last $18 out of the insurance companies, and she doesn't draw a salary. But they do not like the solo private practice model. They are in their early 50s and feel it is a thing of the past (for obvious reasons beyond the scope of this post). They have been planning to find something else for quite some time, as soon as various family matters are settled.

While compiling a list of jobs...I would talk to individual physicians who are actually doing this.
posted by skbw at 10:20 AM on July 28, 2013 [1 favorite]

Since it is difficult to work with a partner/spouse in roles that have obvious direct superior/inferior roles, if your partner is at all interested in business management/accounting... this would make you nearly equal partners in the practice.
Or, if he is interested in the medical side of things, being a NP or PA puts him on a better footing with you as well. It would be more difficult if he was just one of several people doing the same job level, because while he was technically the same as other staff, he wouldn't really be one of them because, well, he sleeps with the boss.
I've worked as a dental assistant in offices where the wife of the dentist was a hygenist(one of two hygenists there) and where the wife was the office manager. It was much better in the office where the wife was the manager, because in the office where the wife was a staff member, she still had authority as a boss too. Too many people were trying to be bosses there!
posted by Jazz Hands at 10:24 AM on July 28, 2013 [4 favorites]

My dad is a doctor and my mom is a nurse. They worked together (in the same practice) on and off for years. It was not a good thing.

Are you sure you guys want to do something like this so badly that your partner would make a significant career shift in order to make it possible?

The only thing I think would maybe be worthwhile would be, if you plan to go into practice for yourself, and if your partner is business/accounting inclined, that could be a good match. But I don't know that I'd suggest your partner change to an accounting field only to help you with your practice.

If you don't know that you necessarily plan to be in a solo practice (which as skbw is somewhat a thing of the past -- even my dad, who did that for decades, ended up merging with a few other practices to become a larger clinic), I would suggest that your partner shift careers towards what he wants to do. Because what happens if he goes back to school to become a nurse or an accountant or something and then you end up at some sprawling practice with dozens of doctors and a perfectly functional support staff?
posted by Sara C. at 10:30 AM on July 28, 2013 [6 favorites]

One of the family physician's I work with has his wife, who is also an RN, as his office manager. It seems to work well for them, and he spends enough time out of the office on calls that they don't get too sick of each other.
posted by pintapicasso at 10:40 AM on July 28, 2013

My mom has been the person in charge (bookkeeper/accounting/buying, etc) things for my dad's cliinic as long as they have had it. While I wouldn't say that she loves the job, it does have the benefit that she is able to most of the work from home, particularly since they got high speed internet and remote accessing. This was really great for my parents, since my mom could be at home with us kids. If you want kids, and he doesn't have a desire to actively work with patients, being the back end businessman could work very well for your overall life.
posted by florencetnoa at 11:04 AM on July 28, 2013

How about landlord or building manager of the building where the office is located?
posted by Corvid at 11:31 AM on July 28, 2013

I haven't seen Physician's Assistant mentioned. PAs basically run a lot of private practices.

Outside of primary care, there are also respiratory therapists, occupational therapists and physical therapists. All well-paid and important roles in hospital-type settings.
posted by killdevil at 11:37 AM on July 28, 2013

If it's part of a larger office, how about IT staff?
posted by spinifex23 at 11:40 AM on July 28, 2013 [1 favorite]

I would recommend finding a physician (or several) who have practices you'd like to emulate and talking to them about this, both for research in potential roles for your partner and for a sense of trends that will determine feasibility in going this route.
posted by emkelley at 11:43 AM on July 28, 2013 [1 favorite]

If you are in the U.S., the chances of being in private practice as a primary care physician when you finish medical school and residency are vanishingly small. Like, so small that this scheme is a terrible idea and not a good use of anyone's time.
posted by jeoc at 11:46 AM on July 28, 2013 [4 favorites]

I think there is a field called Practice Manager. The two that I met perform roles from HR to Office manager" type stuff, and from my observation are highly respected by the chief doctors in the practices. Guess they keep life running smoothly in all aspects.
posted by Lornalulu at 11:55 AM on July 28, 2013

I would echo emkelley's advice and find someone knowledgeable about the current conditions and future trends of how healthcare is going to be provisioned and ask their advice.

I would also suggest that it would be less risky if your spouse/partner worked in something unrelated to healthcare. You still have a ways go to before deciding on a field, finishing your training, and practicing independently. What your partner decides now may not match up with what you're ultimately going to be doing. Having both incomes in a household depending on the same field/sector makes it risky and I would avoid that as much as possible.
posted by scalespace at 12:01 PM on July 28, 2013

I vote practice manager. I think NP or PA could get a little dicey or uncomfortable. It seems those roles are too close to what you would be doing.
Practice manager is very fulfilling (my mom managed a single physician practice for years) and your partner would have a lot of important stuff on their plate (HR, marketing, OSHA compliance, insurance, planning practice growth, accounting etc). They would not have to do everything day to day of course but would need to know enough to oversee it.
posted by TheLibrarian at 12:06 PM on July 28, 2013

My parents worked together for 20 years, it was fine. It's going to be down to you as a couple, there are no hard and fast rules about it.

One of my ex's dad was a doctor and my ex's mom did their insurance billing as her dedicated job. It was a half-time job that gave the family flexibility. That was great.

What was not so great was that when they divorced, she had no equity in his practice and ended up financially screwed. You may want to address that so the non-MD partner doesn't get shafted in a worst case scenario.
posted by DarlingBri at 12:09 PM on July 28, 2013

I'm the IT person for a law firm. My GF of several years is a legal secretary there for the past few years. We're looking forward to eventually not working with each other.

Full time IT people are needed in every decently sized business.
posted by Brian Puccio at 12:21 PM on July 28, 2013

Every medical office I've worked at where the office manager has been the physician's spouse has been a nightmare. I will never work in an office like that again. Ever. Ever. Ever. I'm a PA, for what it's worth.

I would suggest having your partner in a role where he/she has little to no supervision of office personnel or matters. I'm not suggesting that your partner is not capable of running your practice or that you two dont have a healthy relationship but if there is a problem your employees will never feel comfortable voicing concerns or confident that they will be addressed. Particularly if either of you are ever the problem.

Billing and coding sounds excellent.
posted by teamnap at 12:23 PM on July 28, 2013 [2 favorites]

My primary care doctor's wife is his office manager. It's a large practice with a few other doctors and she manages the whole thing. They're very happy and have done this for 20+ years.

Outside the medical field, to address the naysayers, my parents have been the sole proprietors of a small business together for 20+ years. Working together suits them -- it makes them happy to be together most of the time. It doesn't mean they love each other more than other people who wouldn't thrive on that lifestyle, it's just a compatible preference they share. I'm assuming that because you and your partner are on board with this plan that you share that compatible preference, so I think it's a great idea.
posted by telegraph at 12:29 PM on July 28, 2013

There are definitely still practice managers out there, but it is very important to note that medical practices of all kinds around the USA are consolidating and being bought out by large companies, and things like billing and coding are all being outsourced to dedicated companies as well, so having in-office people to do that might not be likely to be the case in your future practice.

Also, I really don't think your SO should make any huge career change decisions based on whatever you think you'd like to go into right now, before you've been to medical school. The majority of medical students change their minds about what they want to do during the course of training, and many more change their minds after starting internship. Overwhelmingly, people choose NOT to go into primary care, and many people choose to work for hospital groups rather than to be in private practice, for many reasons.

A lot of the practices you see that you may think are "private practices" are actually owned by big mega-group practices and are not actually freestanding businesses. With the huge amount of paperwork and reporting that is currently involved in healthcare, it just makes more sense for a centralized office to be in charge of all that and for the practices to just be devoted to providing the care. So, just echoing a number of the excellent points made above. But also, returning to the fact that even if you find a mentor and feel like you know what you want (I did this prior to going to med school), you might end up making a 180 degree change. I switched specialties for residency applications after already having my letters of recommendation made up and my schedule made up with sub-internships for 4th year in the first specialty - despite having shadowed for months in that specialty before starting med school and having a great mentor - and thank god I did. I am a much happier person today for it.
posted by treehorn+bunny at 12:50 PM on July 28, 2013 [1 favorite]

To clarify, not at telegraph directly but in general, my doubts are about the huge changes in health care delivery that are coming or soon to come, rendering the mom-and-pop practice even quainter than it already is, NOT about the feasibility of working together as a married couple.

My parents are divorcing after 28 years together, 15 in business together, so there's anecdata on both sides.

To answer the question seriously, why not become an MSW? In the era of patient-centered medical homes, this is just as likely to result in coworking (or referring clients back and forth) as any of the other ideas.

I have some experience with "midlevels" (PAs and NPs). This is quite an educational and financial investment with many upsides and pitfalls. Don't train as either one unless you want to BE THAT THING independently of a partner's plans.
posted by skbw at 12:50 PM on July 28, 2013

Then there's patient relations, or being a patient advocate--you can work in the same hospital.
posted by skbw at 12:52 PM on July 28, 2013

Couple 1: married with kids, doctor husband and wife nurse worked different departments in the same hospital. Worked out OK; schedules were based on their own preference but they shared a ride sometimes.

Couple 2: married with on kid, both workaholics in a small office. Lawyer husband and secretary wife. Kid's latchkey since they're never home; they're pretty unhappy and that spills over to others in the office.

Couple 3: Once married, now separated or divorced couple share a law firm as the two major lawyers. Draaaaama.

posted by mibo at 1:24 PM on July 28, 2013 [1 favorite]

A saner goal might be "end up working at the same hospital, but doing mostly-unrelated stuff in different departments."

You'd get most of the same perks that you'd get from opening a practice together. (Carpool! Get lunch together occasionally! Share workplace gossip!) But you wouldn't be putting all your eggs in one tiny little basket — instead of worrying that the practice would go under and you'd both end up jobless, you'd get the security that comes from having two mostly-independent incomes. (Assuming the whole hospital didn't fold; but that's much less likely.) And you wouldn't be stuck in the same room working on the same projects driving each other batshit all day every day.
posted by Now there are two. There are two _______. at 1:32 PM on July 28, 2013 [1 favorite]

The majority of medical students change their minds about what they want to do during the course of training, and many more change their minds after starting internship. Overwhelmingly, people choose NOT to go into primary care, and many people choose to work for hospital groups rather than to be in private practice, for many reasons.

Cosigning this, hard.

My dad started med school thinking cardiology. He had also done medical research during undergrad and had serious thoughts of going the MD/PhD route.

Then I happened and, for a variety of reasons that are probably too complicated and personal to list, but which he explains as "I saw my baby and realized I loved kids and wanted to work with them", he ended up choosing pediatrics -- and specifically primary care pediatrics -- instead of Cardiology with a more research-related bent. After his peds residency, despite an intent to be in a larger practice in a city, he ended up taking over a solo practice from one of the pediatricians in his hometown.

I'm pretty sure that, when he started med school, he did not in any way imagine himself as a small town solo practice primary care doctor. And this is 30+ years ago, when the medical landscape was much simpler than it is now. I can only imagine that things are even more complicated nowadays.
posted by Sara C. at 1:41 PM on July 28, 2013

I am about to enter medical school... he could switch to a job in healthcare that would enable us to work together after I finish my residency and begin my practice

Many people who start medical school end up in a different specialty than they thought they would have. You might find a particular specialty that you are especially good at or fascinated by.

Also, starting a private practice can be expensive, and there may be legal changes that make it more expensive than it is now. And after that you have to find patients, patients who don't have a PCP already or who want to change to a new one, which takes time and money. You might be losing money after you pay your rent, staff, and insurance for the first year or more. It's a big financial risk to take (for both of you, if your finances are combined) when your alternative would be to take a well paid job with a guaranteed paycheck, benefits, and paid vacations.

If your partner chooses a career based on wanting to work together with you, you could feel a lot of pressure to start a private practice even if that wouldn't be the best decision for both of you financially or for other reasons.

Also, many of the things suggested are jobs that your partner could do for a private practice, but that's not the same as working together. Billing and coding, for example, can have little enough need for directly working together that it might not even take place in the same building.

If your partner is making the decision on a new career based on working together with you, the two of you need to sit down and talk about what exactly working together means to each of you, and why that's important. Is it spending a lot of the workday around each other? Working to solve the same problems? Working in the same building? Working for the same business? What appeals to each of you about these things. What appeals to each of you and why about each of these things? These are not questions that need to have a "we" answer, you don't have to have the same reasons for wanting these things -- the reason to talk about them is to find out what you each think of them as individuals, and it's OK if the answers are different.

Someone above mentioned being able to have lunch together as a possible benefit -- if it's important to you to have leisurely lunches with your partner, becoming a private practice PCP not a good path to make that happen.
posted by yohko at 2:23 PM on July 28, 2013 [2 favorites]

Rather than focusing on working with you, your partner might want to focus on training for a job that accommodates frequent relocation well. You may end up moving to different places as an intern, resident, fellow, staff physician, etc., and it could make things a lot easier on your partner if they're able to move with you AND find work easily. In the end, that could be a lot more valuable than eventually working with you in the medical field 8-10 years down the road.
posted by Maarika at 3:45 PM on July 28, 2013 [4 favorites]

If the situation were reversed, with him in nursing school and you wondering what career to pursue in order to work near/with him, no one would ever suggest that you go to medical school. That would be crazy! All that work, all that studying, all those sleepless nights and stress... No one should go to medical school unless they really want to be a doctor, right?

Nursing is the same. It's stressful, sometimes emotionally exhausting work requiring a broad range of skills and a deep knowledge of anatomy and physiology, pharmacology, and psychology. And while it is an entirely different scope of practice, nursing is every bit a vocation, requiring the same determination, passion, and commitment necessary to be a good physician.

If your partner's only reason for becoming a nurse is to work with/near you--meaning he has no passion for nursing and no other reason fur pursuing it as a career--he will be miserable in nursing school and will frankly not be a good nurse. No one should go to nursing school unless they really want to be a nurse.
posted by jesourie at 4:44 PM on July 28, 2013 [3 favorites]

I echo what several above have said: people frequently change intended specialties after starting med school (anecdata: I thought I'd be a psychiatrist, I am now a surgeon). Also, the structure of medical practice is changing rapidly; who knows what sort of practice environment you will have by the time you finish residency.

Instead, why not have him consider jobs/careers that will complement you well? You may well move several times (residency, possibly fellowship, first attending job). Your hours in med school are long (but can involve a lot of study at home). Residency hours are just long, even with work hours reforms. It is difficult to manage other parts of your life (laundry, paying bills, etc). I don't know what he does now, or where his interests lay, but maybe consider things like portability, flexible schedule, part time/work from home.

Finally, medicine can be kind of an overwhelming/all-consuming job, particularly early on. There's a lot to be said for a spouse/partner who has a different perspective. It helps keep work from bleeding over onto home quite so much.
posted by maryrussell at 5:32 PM on July 28, 2013

Primary care doctor here! There are still solo practices in all specialties out there, but they are an increasingly small percentage of the total. If you're planning to work with rich urbanites and not take insurance or in a very rural area it's more realistic. I personally have a salaried job with an academic center.

I will add that TPTB at my medical center frown on spouses working in the same physical area although there are lots of couples working at the same institution (and my folks worked happily in offices down the hall from one another, albeit in different departments, for 15 years).

HOWEVER! You asked for some jobs. Here is a list from our large multispecialty practice:

RN (one of whom is primarily managerial, the others are clinical)
Licensed Practical Nurses
Medical Assistants
Certified Diabetes Educator
Health Educator (non diabetes)
Radiology tech
Social workers
Clinical research staff

"Patient services" ( reception, call center, customer service/complaints)
Clinic administrator
Data manager
Internal administrative secretarial staff
Referral coordinators

IT support
Regulatory compliance
Lab techs

Hope that's useful!
posted by The Elusive Architeuthis at 7:03 PM on July 28, 2013 [1 favorite]

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