Private Practice vs. Hospital Employment: Which is the Best Fit?

When it comes to choosing between working at a private practice or finding employment through a hospital, the choice can be a difficult one for healthcare providers of all specialties. Private practices are almost exclusively for-profit, corporately structured businesses. Hospitals, in contrast, vary in their structure, as either for-profit, non-profit, or government owned—though it should be noted that for-profit hospitals make up less than 20% of the total hospitals in the United States.

There are pros and cons to working in both environments, and physicians will have to weigh them before deciding which workplace best suits them.

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Private Practices

Private practices, as previously mentioned, are structured in a corporate manner, meaning that one or more physicians own the practice and employ other staff members. But what are the perks and drawbacks of working at a private practice?

PROS:

  • Physicians have full autonomy: Providers have the free-range (within legal constraints) to make decisions based on their personal preferences, rather than a set-in-stone hospital policy. Decisions regarding software purchasing, payment plans, and other managerial items are completely in the providers’ hands.
  • Private practices offer a learning experience in a wide array of subjects: In a private practice setting, physicians have the opportunity to learn more about marketing, finance, IT, contract negotiation, RCM, facility management and more. Why? Because they’re an independent entity, and the management of all of those add-ons of a practice are their responsibility along with caring for their patients.
  • Private practices have a more relaxed atmosphere: In the absence of hospital policies and regulations, private practices offer their physicians the ability to set their own company culture. Many patients report that private practices have a more “family-like” feel than their hospital counterparts.
  • More patients, more rewards: More patients mean more professional experience and more financial incentives. Hospitals may have a cap or a rotation system in place to ensure all physicians are paid the same—private practices often lack such rigid rules.

CONS:

  • A lack of internal movement: There’s no chance of forward movement in a private practice. If you’re a lead physician or co-owner, you’re already at the top of the practice’s food chain.
  • Base salaries are often less substantial at private practices: Private practices cannot offer physicians hospital-rate salaries—if a physician fails to offset their expenses, it means a significant loss of revenue.
  • Physicians may find themselves in an ultra-competitive work place: If the practice is operating under a “eat what you kill” mentality, physicians may find themselves pitted against their coworkers, resulting in conflicting priorities.

Depending on your personal preferences, the benefits of working at a private practice might balance out the detracting factors—or they may not. If they don’t, a hospital may be more your style.

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Hospitals

Hospitals differ from private practices in numerous ways, not least of all considering their average size. The increased patient flow and varying departments results in a completely different work environment—complete with its own set of pros and cons.

PROS:

  • Administrative responsibilities are delegated to other staff members: Hospitals have departments and numerous staff members to handle human resources, billing and collecting, rent and overhead, as well as day-to-day operations. A physician’s focus will be fully on their patients.
  • Higher income is almost a guarantee: Typically, hospitals simply have more capital to level at physicians. Pay is not only higher, but also guaranteed, as opposed to at a private practice where money coming in must also be used for a number of administrative purposes.
  • Teamwork makes the dream work: As there are a variety of departments to be found in a hospital, parts of a patient’s care can be delegated to the relevant providers.
  • Opportunities for continued career growth abound: Given the number of positions in a standard hospital, the potential for upward momentum is high. A physician may begin their career as one of many in a department, and eventually become a Vice President or Head of Medicine within the hospital.

CONS:

  • A loss of independence: Many physicians struggle with the constraints of working at a hospital. Once they’ve signed a contract, the hospital has the right to dictate where they perform surgery, what tools they rely on, and what materials they have.
  • Compensation may not be constant: While the initial financial compensation may seem stellar, hospitals can—and do—change their production-based formulas. The security of an offer upon employment is something that should be legally and firmly agreed upon.
  • Technology may be new and unfamiliar: Not all EHRs are created equal, and the system you’re accustomed to may not be the same as the software the hospital relies on. Making the switch may be frustrating and time consuming.

Every physician has different wants and needs when it comes to where they work. Hospital or private practice—it’s not so much a matter of the “best” choice, but simply what’s “right” for you.

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