For physicians just entering practice, the choice between private practice and hospital employment can come down to a trade-off between autonomy and financial certainty, according to Eric Taris, MD, a hand surgeon who joined Appalachian Orthopedics in Johnson City, Tenn., after completing his fellowship in July.
The decision plays out against a broader industry shift. Hospitals or corporate entities now employ 82% of physicians nationally, up 5.6 percentage points over the past two years, according to a 2026 report from Avalere Health and the Physicians Advocacy Institute.
Orthopedic surgeons, however, have resisted that trend more than most specialties. Fifty-four percent of orthopedic surgeons remained in private practice as of 2024, according to the American Medical Association’s biennial Physician Practice Benchmark Survey, well above the 42.2% private-practice rate across all specialties.
Dr. Taris told Becker’s that hospital employment is not seen by his peers as something that holds them back professionally; rather, it is viewed as the safer bet financially. Hospital jobs typically come with a strong starting salary and an easier exit if the position does not work out, he said, which is part of why some young physicians are choosing hospital roles in rural communities in particular.
“They see that it will last them, that they can go there and make a lot of money, and then if it doesn’t work out, they can just leave,” Dr. Taris said.
Private practice carries a different risk profile, he said. New hires generally take a pay cut in their first few years and must wait roughly two years to reach a partnership track before seeing a full return on that investment. That timeline creates its own exposure: Physicians who join a private practice shortly before it is acquired by private equity can miss out on the payout entirely if they have not reached partner status.
He added that much of what young physicians learn about that financial calculus, including how private equity consolidation affects new hires, tends to happen on the job rather than in residency. For his own decision, Dr. Taris said autonomy outweighed the financial trade-off. He wanted control over scheduling and staffing decisions rather than working within a hospital system’s constraints, and he chose a fellowship program run by a private practice to gain exposure to the business side of medicine before starting his career.
“The business side of it doesn’t get taught in residency a lot,” Dr. Taris said. “But I was exposed to quite a bit with my training.”
Dr. Taris said he had strong ties to the Johnson City area and confidence the practice would be a long-term fit. This calculation, he said, is harder for physicians without that local knowledge, since evaluating a private practice job often means committing to a community after just a handful of interviews.
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