HealthFebruary 03, 2020

Working at a hospital vs. private practice: What's right for you?

By: Whitney J. Palmer

After residency, working at a hospital might seem like the logical next step in your medical career. But hospital employment isn't the only option. Depending on your long-term goals, launching into private practice could be the best fit.

Before you choose one employment path over the other, take the time to understand what each situation will involve. Which one matches up with your personality and your career goals? Will one better meet your salary needs? Thinking about these things beforehand can help you make a more informed decision, potentially saving you from having to make a switch mid-career.

Personality and lifestyle

Deciding between working at a hospital or starting a private practice — either solo or as a group — can largely depend on your personality.

Hospital employment: You might feel more comfortable working at a hospital if you'd prefer to focus solely on clinical activity and don't want administrative responsibilities. This work environment also makes it easier for you to maintain work-life balance, since you can rely on a greater number of co-workers to see your patients if you need time off.

Private practice: You'll likely lean toward your own private practice if you like to control most aspects of your work and if you've carved out a niche for yourself in the industry, according to Practice of the Practice. Private practice might also suit you if you like working alone and tackling responsibilities outside of treating patients, such as marketing, human resources, budgeting and billing.

That said, you can still go into private practice if you want a group of co-workers. Opting for a group practice, where you partner with other physicians from a single or multiple specialties, can give you a more collegial, social environment where you can easily network and collaborate with others.

Career goals

The path of your career could differ greatly if you opt for hospital employment over private practice.

Hospital employment: Working at a hospital offers you a steady paycheck that isn't dependent upon the number of patients you see or additional administrative responsibilities. And while you might start out as a new physician with a heavy call load, hospital employment frequently offers greater opportunities for career advancement, positioning you for increased responsibility and higher income in the future.

Private practice: If you don't like working with others and prefer to be your own boss, solo private practice is likely better for you. According to MicroMD, it may be easier for you to retain patients with this practice model because many like the familiarity of seeing the same doctor, front desk staff and nurse at every visit.

A group practice may bring some of these same benefits; as a bonus, the business infrastructure will likely already be in place when you get there, saving you the time and stress of having to figure out all the logistics.

Salary needs

Compensation for your services can be complicated. According to a 2018 Medical Economics report, physicians working in private practice make, on average, $301,000 annually. Physicians working for inpatient hospitals typically make $278,000, and doctors employed in nonprofit hospitals earn roughly $228,000. What you actually make, however, can depend on many factors, including your patient volume, reimbursement rates, hospital revenues and other expenditures.

Hospital employment: If you choose to work at a hospital, the administration will largely determine your salary. It will be a steady income, but it is ultimately limited by the hospital's overall revenue.

Private practice: If you opt for private practice, you must budget for staff salaries and overhead expenses. Your salary can fluctuate — it will be tied to the number of patients you see — and will depend on the revenue you bring in above those costs.

Practice characteristics

You'll provide patient care no matter where you work, but here, too, there are crucial differences between hospital employment and private practice.

Hospital employment: Working at a hospital guarantees that you'll have a referral base from other physicians in the facility, and you can expect to see a certain number of patients every day. Hospitals are also in a position to negotiate better reimbursement levels from insurance companies, making you freer to focus on meeting patient needs instead of worrying about the bottom line.

Private practice: If you're in private practice, you can run your office according to your own preferences. Not only do you choose the care options, but you also have control over day-to-day business operations. Ultimately, you set the tone for the office culture. If you opt for joining a group practice, however, the preexisting business infrastructure might not offer as much flexibility.

How do you decide?

Deciding whether to pursue hospital employment or private practice can be complicated, but you don't have to make the decision alone. Ask your colleagues and peers in various practice models to describe what they like and don't like about their employment. Think about whether you'd like to make an impact for a small group of patients or if you'd prefer to apply your skills in a larger environment. And be sure to think about where you see yourself in 10 to 15 years. Do you desire upward mobility and responsibility that goes beyond patient care?

Answering these questions will help put you on the right career path right out of residency.

Whitney J. Palmer