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I cannot speak to other 'employed' models...but regarding the Permanente model for all the naysayers who 'know' someone in the model or spent a short amount of time in it...No nurse has ever told me or another physician how things are going to be done. They work for the Health plan, not the Permanente medical group. The Permanente medical group for each Kaiser region is separate from the Health plan...The medical group is solely run by physician leaders...and just like 'shareholder' physicians, if the nurses or health plan employees are not up to snuff, they can and do get fired. Is it more difficult to get rid of someone than in a smaller private practice...sure...but it is done all the time.
I have practiced in the USAF, private practice (fee for service), and now Kaiser...every model has its positives and negatives...for me, this has been the best model (most fulfilling professionally) I have worked in...by far...
As I mentioned in a previous post...I am a Chief and due to a large expansion for us where I practice I have had the opportunity to hire many (12) anesthesiologists in the past year...I have had many more CVs than candidates and the docs I have hired are all stellar candidates...most leaving private practice. For residents, across all specialties, we are getting the best candidates from the best programs applying for our positions. You can be in denial about the changes on the horizon...but there will be a price to pay if you bury your head in the sand...my 2 cents anyways...
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