Hospital-owned or Private Practice: What Doctors Should Know

As doctors there’s no shortage of working conditions and environments. You have the option of working in a hospital, a private practice, or even alone as a solo practitioner. This makes your choices a little more varied than say someone who works in marketing who will most likely need to work in a company. There are definite differences between working in a hospital and in a private practice and we’ll visit the pros and cons of each in a little bit. We won’t be visiting the option of working as a solo practitioner as it’s becoming less and less of a reality these days. Setting up shop after graduating will be very difficult as there’s simply too much to handle on your own regarding rules and regulations. There’s also the issue of building a reputation and a rapport with patients which might take too much time.

After graduation physicians need to undergo training which happens in hospitals. Fresh graduates apply for the MATCH and they go to interviews then find out afterwards where they’ll have their residencies. So basically everyone starts at a hospital, however; what happens after the residency is over is up to the individual. You may get an offer to continue at the same hospital, another hospital, or seek work in private practice. This will depend on your personality and the kind of environment you prefer as each option offers something different. Let’s talk first about hospital practice.

Being employed in a hospital has a number of perks which mainly result in it being the safer option especially for younger doctors. For starters a hospital will already have a patient base and a regular amount of patients who visit it considering that it’s where most people who leave nearby will visit. This will save you having to build a client base from scratch. The hospital also relieves you from many responsibilities such as administrative and financial duties. You don’t have to hire anyone and you’re not really responsible for anyone. You also have fixed hours which may be a relief for people who are used to working a fixed amount of hours each day or week.

In a hospital you’ll also get to see a wider variety of patients. Most people who visit a hospital aren’t chronic cases who are just looking for a follow up. They’re most likely going to be acute cases or chronic cases with exacerbations. If you’re into seeing a wider variety of cases then working in a hospital will provide you with that excitement.

You don’t need to worry about getting paid while working in a hospital either. Talking to insurance companies isn’t something you need to worry about. The hospital will handle all that paper work and you’ll receive your money without having to worry about what going on behind the scenes. Basically working in a hospital can be a bit of a routine and you may occasionally feel like an employee, but it gives you the luxury of not having to worry about a lot of things. You also get to see more in terms of medicine which will keep you on your toes and boost your skills as a physician.

Unfortunately nothing is perfect so there are some cons to working in a hospital. One of the major reasons some doctors especially surgeons prefer to work in private practice is autonomy. If you’re working in a hospital you may find yourself a bit restricted. If you’re a surgeon then you’re restricted by the hospital when it comes to the materials and devices you use for surgery. These restrictions may bother some doctors who choose to have more freedom when it comes to their work.

Working in a hospital may be a relief financially like we said. Your first contract has a great salary and you don’t need to worry about insurance companies and so forth, but there are financial drawbacks as well. For instance, if your performance is less than what the hospital expects and you’re not bringing in the kind of money they want you to then your next contract may be worth less than your first one. This can be stressful and bothersome to lots of people especially as negotiations for a new contract begin. Your contract may also contain restrictions that prevent you from working in another hospital in the same area for example. If you quit or your contract with your current hospital is terminated this would force you to leave the entire area and look for work somewhere else.

Now let’s take a closer look at working in a private practice and see the perks and downside of it. Like we recently said, a hospital may limit a physician’s autonomy and treatment options. This is where a private practice shines. You are your own boss and you have full autonomy and the freedom to do for your patient as you see fit. You get to choose which hospital you perform the surgery and the material and equipment you prefer.

Another perk of working in private practice is that there’s no limit for how much you make. It’s true that working in a hospital provides safety because even if you don’t get many patients you don’t risk making less money, but what if you are successful and want to make more? You could work as much as you want in a private practice and the extra work will mean extra money. In a hospital, however; you can see 15 patients or you can see 60 patients and at the end of the day you’re still making the same amount of money so there’s really no reason for you to work harder and actually want to do extra work.

In a private practice you get to decide your working hours and vacation time. You could do this in coordination with your peers so that you can cover for each other in a manner that suits everyone. Basically no one can tell you when to come into work and how long you have to stay.

It’s not all rosy on the private practice side though either. We said there’s no cap for how much you can make in private practice, but there’s also no safety. If you’re not really contributing to the practice and bringing in money then naturally you won’t be able to make much money. You’ll need to bring in money to the practice in order to make it which can be difficult especially if you’re just starting.

Private practice gives you more autonomy that also means more responsibility. You have some wiggle room to do things as you see fit but you can’t forget that your private practice is still a business and that like any other business it has rules too. You’re also going to have to make sure that your private practice reinvents itself every few years in order to keep going. Being successful for a couple of years doesn’t mean that you’re set for life. Medicine is ever evolving and in a few years things may change so that you find yourself falling behind. You have to constantly stay on top in order to make sure you don’t have a lot to make up for.

Basically there’s no perfect practice option or else everyone would be doing it. It all depends on how experienced and successful you are as well as your personality. If you’re looking for job security, an already present base of patients, a wider range of cases, and aren’t bothered by the restrictions and salary cap then you should look for hospital employment. This is also true if you’re just starting out your career as a doctor. If you’re confident of your ability to bring in patients and therefore the ability to make more money, don’t like being told what to do, and aren’t afraid of making sure your practice doesn’t fall behind then private practice is for you.