While private practice offers more freedom, flexibility and independence, it can often be more challenging and offer less compensation and fewer resources.
Twenty-one ASC experts weighed in on the pros and cons of private practice over employment:
Janet Carlson, MSN, RN. Executive Director of ASCs at Commonwealth Pain & Spine (Louisville, Ky.): For many physicians completing residency and fellowship, employment with a health system often guarantees a larger starting salary, which is a boon for an individual having to repay large amounts of medical education expenses. I think it is safe to say that many physicians in training do not learn the “how to’s” of private practice and the many opportunities for earning income via this model. I believe that healthcare would benefit from more independent private physician practices to exist outside of the ever increasing health system consolidation occurring in America today. One of the greatest benefits of private practice is the autonomy to treat the patient with individualized care. This is enhanced by the ability of the physician to pivot to adopt newer technologies and interventions that would improve their patient outcomes and satisfaction. If you are a surgeon in private practice, it would be ideal to be a partner shareholder in an ASC where she/he would have access to guaranteed OR block time. ASCs represent a tremendous opportunity for surgeons to manage their increasing surgical case demands in an accessible, safe, and affordable site of service.
Shehzad Choudry, MD. Director for Interventional Spine and Pain at Orlando (Fla.) Health Interventional Spine Pain Department: The biggest benefit is that I don’t have to worry about operations of the practice. I focus on providing the best clinical care for my patients. When I worked in private practice, I spent at least 10 hours a week, addressing all sorts of issues — staffing issues, compliance, as well as making sure we had enough hand soap and toilet paper. You cannot compare the two types of practices as they are so different. The grass is not always greener. But being employed works for me and it does let me focus on the best care for my patients.
Harel Deutsch, MD. Co-Director of Rush Spine Center (Chicago): Overall, I think that private practice is important for the future of the medical profession. Once you are an employee, you lose autonomy and control of your environment to a great degree. Working as an employed physician, there are some advantages, such as the ability to work in a large organization with more resources. Physicians are more able to concentrate on just patient care and they can have a more predictable work schedule.
James Flaherty. Professor of Cardiology at Northwestern Medicine (Chicago): The upside includes that contract negotiations with vendors are typically taken care of, capital costs for new equipment are covered and benefit/retirement plans are standardized.
Brian Gantwerker, MD. Neurosurgeon at the Craniospinal Center of Los Angeles: Working as an independent neurosurgeon has been an extremely fulfilling part of my life. If anything, at the beginning, I didn’t know how to properly balance family time and work time. I found myself doing charting late at night and not paying attention to my family.
I’ve learned to balance things much better now while maintaining an independent private practice. Being able to manage my own schedule I can make sure I’m getting enough family time and that I can go on hikes with my son and go on day trips with my wife when he is away at camp. You can set your schedule, see the cases you’d like to see, and collaborate with people outside of your group.
As opposed to an employed physician, you were locked into a system and rarely can go outside of it. Your choices for specialists to collaborate with are very limited and oftentimes may not be the right fit for the patient. In addition, employed physicians end up costing the economy, more in terms of money as you were in fewer private practice people who live outside of the virtual bubble. My hope is that we will discover the value and virtues of private practice in order to control costs rather than just reap more rewards and profits for the hospital systems and insurance companies. The point being, we get one trip in this life and it’s very important to carefully consider your career choices to maximize your chances of enjoying that trip with the ones you love.
Ramis Gheith, MD, BSN. Anesthesiologist and Medical Director at Interventional Pain Center of Chesterfield (Mo.): Choosing between being an employed physician and running a private practice involves trade-offs in autonomy, financial risk and work-life balance. Here are the key advantages of being an employed physician compared to private practice:
1. Early financial security and predictable income. This disparity changes after approximately two years.
2. Lower administrative burden.
3. Access to resources and technology. Hospitals and large healthcare systems provide advanced medical technology and equipment. Easier access to multidisciplinary teams and specialists for patient collaboration.
4. Established infrastructure for research, education and continuing medical education.
5. Legal and liability protection. Employers often cover malpractice insurance or offer subsidized coverage. Less personal financial risk if a lawsuit occurs.
6. Opportunities for leadership roles within the hospital system.
7. Potential for signing bonuses, relocation assistance and loan repayment programs. This may be appealing for some doctors with larger financial responsibilities after residency/fellowship.
Downsides to consider: Less autonomy in decision-making, including patient care protocols. Potential productivity pressures, such as RVU-based compensation models. Corporate influence on medical decisions and scheduling. Limited earning potential compared to a successful private practice.
Ultimately, the decision depends on your priorities and if you value stability, lower risk and fewer administrative burdens, employment may be the better choice. However, if you prioritize autonomy, income potential and future success with ownership and value — private practice wins.
Omar Khokhar. Gastroenterologist at Illinois GastroHealth (Bloomington): I think it’s important to note that there’s no perfect situation in this current healthcare environment. Employment shields physicians from reimbursement adjustments from payers, and generally leads to a built-in referral stream. Economically, there are advantages with having a protected salary along with the usual insurance and retirement benefits.
Andrew Lovewell. CEO of Columbia (Mo.) Orthopaedic Group: There are pros/cons to both routes. Employed physicians traditionally have a few of the following “pro” features: Stable base salary with a component of RVU bonuses – this may be capped however. Easy entry and exit, i.e., no buy-in or buy-out. Lower financial risk, as they do not have to put up cash for a buy-in or take risk on new business expenses. Access to hospital/health system resources. Less impact on payer pressures, Medicare cuts, and the overall variability in reimbursements that the private practices face. However, private practice physicians have other “pro” features that we should note: No cap on income traditionally — meaning “eat what you treat” model. More flexibility with schedule/time off — be your own boss. Ability to participate in ancillary revenue streams. Control over what new business ventures get added to practice. Can shape the way the practice does business as an owner/partner. Both employed and private practice physicians have pros and cons. One option may be better for certain individuals — there is not a one-size-fits-all model. Employed physicians may have more salary stability, take less risk and reduce stress through less administrative burden. While, private practice physicians have more ownership and control, higher earning potential and autonomy due to the nature of private practice.
Taif Mukhdomi, MD. Interventional Pain Physician at Pain Zero (Columbus, Ohio): As an employed physician, your work and salary is always guaranteed. The schedule and workflow is all dictated by outside forces, which can be a blessing or a curse but ultimately out of your control. Private practice ownership allows you to control for many variables to suit your needs however nothing is guaranteed and that risk may be daunting for some. Employment affords more security, guaranteed income, and some clarity to what your day-to-day is like — private practice days are always changing and may seem risky. However, once you get a grasp over the practice, it’s hard to see the security in being an employed physician.
Yesh Navalgund, MD. Chief Medical Officer at National Spine & Pain Centers (Bel Air, Md.): Being an employed physician offers stability with a predictable salary, benefits and often relief from administrative burdens like billing and compliance. It provides work-life balance, sometimes a built-in referral network, and access to advanced resources within a structured healthcare system. For many, this model allows a focus solely on patient care without the complexities of running a business. However, while employment offers security, it also means adapting to company policies and productivity expectations, which can impact autonomy. Physicians who value greater control over patient care and long-term financial growth may still prefer private practice as an attractive path.
Joseph O’Brien, MD. Medical Director of Minimally Invasive Orthopaedic Spine Surgery at Virginia Hospital Center (Arlington): In markets where physician ownership is preserved, private practice can be quite desirable for orthopedic surgeons. For instance, the ancillaries generated from durable medical equipment, physical therapy and surgery center ownership can rival the actual professional fees that the doctors generate. The main drawback for higher producers is variable overhead assigned on collections. This feature can harm spine surgeons who are partners with general orthopaedic surgeons.
In markets like [the District of Columbia], physician ownership of ASCs, PT and the practice has plummeted. Private equity, [management services organizations]/collective bargaining and other trends in the D.C. market have seized physician ownership of ancillaries and created the concept of “unlimited” overhead — where compensation is strictly based on a percentage of collections. The more you collect, the more overhead you pay. Additionally, the surgery center fees are divided among two to three entities in the D.C. market, making ASCs undesirable in the D.C. market. In this sort of market, employment can be a boon. Where the hospital can tune overhead to less than 30% for some specialities. This trend makes hospital employment much more desirable moving forward in markets such as D.C.
Finally, employment is a good feature for docs over 50. In a setting where a base salary is not guaranteed, illness or injury can reduce compensation significantly. A private practice doctor that has a major illness and is out of work for three to six months will lose a huge amount of compensation. In comparison, a high base salary guarantee from hospital employment can be much more safe for doctors with chronic or acute health conditions.
Peter Passias, MD. Orthopedic Spine Surgeon at NYU Langone Health (New York City): There are certainly upsides to both situations and [are] dependent highly on the individual circumstances. Some of the unique advantages of being an employed physician are the collaboration with larger institutions which have strength in numbers. This reaps benefits with regards to enhanced referral patterns, allowance for sub-specialization of practice and superior bargaining power with payers, and bulk discounts for capital purchasing. One item that requires critical attention in generally larger employed physician models is attention to the needs of the individual, as well as the incentivization of productivity.
John Peloza, MD. Orthopedic Spine Surgeon at Midwest Orthopedic and Spine (Chicago): Physicians will have two main practice models as we advance: employment (Hospital or Health System) and private practice. Each has pros and cons, so the choice depends on the physician’s personality, income goals, and risk tolerance. In the physician employment model, the physician is an employee of the hospital, health system, or significant medical group rather than an independent private practice. Another type of arrangement, a foundation plan, allows the physician to be independent in a small practice but on the hospital or health care system’s insurance contracts. This allows the physician more autonomy but requires significant direction from the hospital system.
The main benefits of this strategy are financial stability (increased reimbursement from insurance plans than private practice) and no practice overhead. Health plans have
better insurance contracts than private physicians, and they can pay physicians more because they can also charge for ancillary services. Reimbursement can be determined
by salary, RVUs, bonuses, or other metrics detailed in a contract. Eliminating practice overhead and administrative burdens contributes to the doctors’ bottom line. The
hospital system also pays for malpractice and liability coverage. In this model, the physician also has all the hospital or health plan resources without the
overhead. These include facilities, technology, EMR, multidisciplinary support, office space, equipment, and staff.
There are many downsides to this arrangement. Depending on your personality, losing autonomy can be a deal killer. The physician must accept the hospital bureaucracy, red
tape, and policies with little input. Depending on the contract, there are productivity pressures and very few entrepreneurial opportunities. This can lead to limited earning
potential compared to private practice.The physician employment model is best for doctors prioritizing stability, reduced administrative work, risk, and predictable income. Private practice gives you complete autonomy, higher earning potential, and ownership equity. However, reimbursement is steadily decreasing in the current medical
environment, with little chance of improvement. Ancillary ownership and revenues can compensate for the decline in physician services but require significant investment and
risk. Presently, the opportunity for young physicians to build a practice with equity they can sell at some point is unlikely. Physicians who join an extensive practice that has
already sold to private equity or something similar have already missed the upside. Private practice is attractive to physicians who value independence and entrepreneurial
opportunities and are willing to handle business operations.
Salvador Portugal, DO. Assistant Professor of Rehabilitation Medicine at NYU Grossman School of Medicine (New York City): The benefits of practicing as an employed physician include less time spent on non-clinical administrative tasks of managing practice finances, staff, and overhead, allowing for more time and energy spent on patient care, teaching, and/or research at academic centers. Employed physicians may have more predictable schedules and stable incomes. Employee benefits are typically more robust and available at lower cost. For example, NYU Langone Health employees are offered low-cost medical insurance options that cover office visits from NYU Langone top tier doctors, no deductibles and coinsurance, and hospitalizations and surgeries covered at NYU Langone facilities at no cost.
John Prunskis, MD. Medical Director and Principal at DxTx Pain & Spine (Chicago): The question needs clarity as there are many subsets of employment such as employment by a hospital, employment by a clinic not affiliated with the hospital, employment by a group owned by private equity, employment by a group owned by a family office, employment by a small group of physicians, et cetera. In 2025, most specialties are not a minimal to a solo practitioner hanging out a shingle.
It depends on the specialty and the group situation that one is joining. The No. 1 criteria is excellent patient care followed by respect for physicians. Extremely important is compliant billing and data driven medical practice. Once a physician finds that a practice situation meets those criteria then the physician can choose what is best for what is best for them given their specialty.
Unfortunately, without a nondisclosure agreement signed by the practice, which will never occur in a physician injury situation it’s virtually impossible to really understand what they’re getting involved with unless they are showing that the practice is extremely thorough and careful and its relationships. In my specialty as an interventional pain physician, the best model I have seen is one in a multi-state, single-specialty group with the highest ethical standards, respect for physicians and sound business practices. Being in strong practice having locations in multiple states provides advantages.
Randal Reynolds. Senior Vice President of Development at HealthCrest Surgical Partners (Oklahoma City): As a non-physician who works with both employed and independent physicians, it has obviously become even more difficult for a doctor to come out of medical school and not become a hospital system employee because of his or her insurmountable student loan debt. One of the main upsides of being an employed physician is the guaranteed paycheck from the employer as well as the opportunity for student loan relief. Another upside would be the built-in referral network from the primary care sources of the hospital system, which provide a steady flow of patients.
For the doctor in private practice, the main upside would be the autonomy in making decisions related to how the practice is operated. Another upside is the ability to retain profits from the business that was set up for this purpose.
Zeeshan Tayeb, MD. Owner and Medical Director of Pain Specialists of Cincinnati: Being on both sides through my career, I can attest that as an employee there is much less to worry about. Prior to opening my own group and as an employee I never really thought about certain facets of daily operations. Being in private practice, I am responsible for the cost of equipment, disposables, staffing, marketing and so many more items. IT comes with much more responsibility. However, the flexibility of being able to be my own boss has been the top reason I enjoy private practice.
Mark Testaiuti, MD. Spinal Neurosurgeon, Partner and Vice President at Coastal Spine (Mount Laurel, N.J.): Having been employed for the first 10 years of my career and then having been in private practice for the next 20, I believe the decision to be employed versus being in private practice is a personal one that revolves around lifestyle and responsibility aversion considerations.
This has been a common conundrum contemplated by physicians over the decades, but more recently in our present time of lifestyle choices over cumbersome responsibility. As the benefits of private practice might be seen as waning with diminishing reimbursement, greater documentation responsibilities, et cetera, the return on investment might not be as attractive for some physicians as it once was.
First, if the goal of being a physician is to enjoy your craft, but not be burdened by all of the administrative and managerial responsibilities, then hospital employment may be more for you. This is particularly true of younger physicians that still feel they need to explore the world while still becoming academically or professionally successful early in their career and may not want or appreciate the value of early equity one gains by being privately employed, if properly managed.
Additionally, working at a prestigious university hospital teaching residents and publishing papers during the workday and then being “off” completely may be enough sweat equity for them, versus slowly gaining monetary equity through private practice employment, building ownership and growth of their personal practice value. This is how my early career was structured. However, more and more I have noticed the trend of younger graduating physicians choosing the “9-to-5” approach and not wanting to be tied down as much to a practice that they own, and need to be responsible for. It is a delicate balance between working to live versus living to work. Some highly regarded hospital employed physicians have figured out how to fill the void of private equity growth private practice affords by growing relationships with industry, having lucrative consulting and speaking engagements, patenting inventions, being involved in research and other intellectual property pursuits. Although this is somewhat off topic, it is definitely a delicate and ethically charged consideration employed physicians face.
Older physicians that are towards the end of their careers may consider this a good option for retirement If they have done less well for themselves or even if they have sold off their practice at a smart profit but feel that they can still produce for another few years after having shed the burden of private practice management for a more straightforward employment option. Perhaps giving back by teaching trainees and staff may be further rewarding for them before they retire. This choice can allow them to slowly transition into retirement with additional 401(k) and lifestyle perks that they might not have enjoyed as a solo practitioner or a in small group.
As for private practice, if one gets through the initial start up and early years of uncertainty, growth and little lifestyle enjoyment, it can become extremely rewarding. Having built something that you own, including real estate and multiple practice locations and using that equity as a means to invest against, can become very profitable, depending on the business acumen of the practitioner. However, steady stream income may vary year to year, depending on the prevailing overhead, and it requires fiscal diligence and oversight to avoid expenses overtaking profit in lean years. There is also the responsibility of risk management HR and insurability. With the risk of lawsuits ever looming, these considerations can be burdensome and frightening enough to avoid private practice depending on the specialty.
As a perk, private practice does allow more flexibility when there may be cancellations etc. with the latitude to do what you like for the day versus needing to “show up at work“ because you are employed. There are other tax benefits to being in private practice, including expense accounts, tax write offs through property ownership, etc. and taking out personal loans for business growth and investment.
Katherine Wagner, MD. Neurosurgeon at Ventura (Calif.) Neurosurgery: There are some serious challenges to working in private practice – including increasing expenses and declining reimbursements – but the upsides are also important. These include increased control over the schedule, ability to take different insurances, the ability to consultant work, and control over what procedures you offer patients and how you set up your entire office and practice. In employed models, physicians lose that control and usually gain financial security. Employed physicians lose control over their schedules, practice patterns, etc. and have to work with administrators who may have very different priorities than practitioners. However, large employers can control costs better and have more negotiating power than individual practices. There is a reason many physicians are leaving private practice.
Corey Welchlin, DO. Owner of Center for Specialty Care (Fairmont, Minn.): Being an employed physician would be of benefit to remove the stresses of staffing, billing , benchmarking and funding your own practice. As healthcare has evolved, reimbursements have shrunk, salaries of staff have increased , pre authorizations have become almost constant, the freedom and joy of private practice has been eroded. The risk is, what happens when all docs/ surgeons /ASCS/ ancillaries are hospital system owned? Free enterprise and and a lot of motivation / rewards of being a clinician will be changed forever.
Nolan Wessell, MD. Assistant Professor and Co-Director for Orthopedic Well-being in the Division of Spine Surgery at the University of Colorado School of Medicine (Aurora): I work in academics but our compensation model essentially makes us private practice physicians as we are compensated based on collection. In the absence of significant ancillary revenue streams or hospital support, I don’t see how private practices are able to stay afloat. I commend those practices who are able to maintain adequate staffing, provide high-quality care and pay their providers a market competitive salary while holding on to some degree of work-life balance. Under the current circumstances, employed practice looks better and better with each passing year as I watch my productivity increase and my collections decline.
Many people argue in favor of the autonomy that comes with running a private practice but, a properly negotiated employment contract would seem to provide the peace of mind and stability required to ignore any worries about practice finances and focus entirely on providing great patient care. Younger providers coming out of training with a mountain of educational debt and inflation adjusted reimbursements declining in the range of 30% to 60% over the past 30 years, it should come as no surprise that new graduates aren’t in a position to buy in to a private practice and instead, opt for the stability of employed positions.
