Private practice vs. employment: What 8 physicians have to say

Choosing to go into private practice or join a large system is one of the biggest decisions physicians have to face. From independence to better pay, there are pros and cons to each. 

Here is what eight physicians have told Becker's about why they have chosen either private practice or employed roles: 

Frank DiMaio, MD. Director of Catholic Health Physician Partners (Garden City, N.Y.): Private practice. Practice management skills including patient throughput, visit workflow and billing are best learned this way.

Eric Esrailian, MD. Gastroenterologist and health sciences clinical professor of medicine at UCLA (Los Angeles): I have always envisioned being part of an academic institution because of the potential to have an impact on the community — and possibly the world. Given the current landscape, employment-based opportunities are appealing for young graduates for many reasons. The long-term income stability, benefits and support are reassuring to many young physicians starting out in their careers. Like UCLA Health, many academic health systems have also created clinician-educator career tracks that provide opportunities for growth personally and professionally while making a contribution to the community. Knowing the landscape, these attributes are exactly what I would be looking for in a position.

Lawrence Kaplan, MD. Associate Dean at the Lewis Katz School of Medicine (Philadelphia): If I was starting over, I would choose employment, primarily because I don't believe anyone is "going out and hanging a shingle," as it used to be called. The business aspect of medicine is unfortunately so complex that I don't know if anyone is savvy enough to do it themselves, even if someone was thinking about direct primary care, concierge, etc. Realize that my answers are based on primary care/general internal medicine, which is what I do, but I believe that you'd get the same response from procedure-based specialists. 

Walter Steigleman, MD. Ophthalmologist and professor at University of Florida (Gainesville): I think employment is likely a better bet for the foreseeable future given current market forces. Large groups and hospital systems have some pricing leverage with insurance companies these days. The smaller practice is just not able to compete, same for personnel issues. In the past few years, all of us have struggled to recruit and retain enough ancillary staff. When these staffing shortages are diluted in a larger practice or medical system, it's less than ideal but the job can still get done. I have friends/acquaintances in small practice settings where they've now been forced to wear many hats including even working up their own patients. Many significant stressors for the small practice these days. Some select folks are thriving in small practices which could be said of any field — be it law, athletics, entertainment, etc. However, I think the majority of folks in small practices are struggling these days and likely will be in the foreseeable future. Changes in reimbursement models and the purported mass exodus of aging physicians in the near future could make private practice of all sizes more financially feasible.

Peter McCunniff, MD. Spine surgeon at the Pain Center of Arizona in Peoria: Over the past year I made a change from a hospital-employed to a private practice model that is closely partnered with interventional pain services. We're now utilizing the model that I believe in and although it's early on, I am very happy with our success and what the future holds. I learned so much from my early experience in the hospital-employed model that has given me the perspective and experience to cut out the inefficiencies and allow the most streamlined care for my patients while also providing me great balance both professionally and personally.

Ramy Elias, MD. Medical Director for the Center for Advanced Orthopedics & Sports Medicine at Cerritos (Calif.) Surgery Center: The current healthcare model is not sustainable.  Decreasing reimbursements and rapidly escalating costs of doing business will accelerate the decline of private practices. This will force many practices to shut down or sell to private equity or insurance companies. Companies such as Optum are rapidly taking over with the guise that they can provide better care. The only path to success is for physicians to band together and stand up to the insurance companies. The divide-and-conquer model has worked well for insurance companies, and we must put an end to this. We need to realize that we are not in competition with our colleagues and we are much stronger together.

Earl Kilbride, MD. Surgeon at the Austin Orthopedic Institute: Myself and two partners, all with 20 years of experience, peeled off from a large single-specialty orthopedic group. We worked very hard to get the message out to the community that we would have two goals as our foundation — one is optimal results while the other is top-notch patient service. Finally, it is coming to fruition. We have hired another partner and have watched each of our practices grow.

Ryan Molli, DO. Whole Health Orthopedic Institute in Meadville, Pa.: I'm disappointed that the pendulum has swung so far toward hospital employment, and one of my main goals is to swing that back toward private practice and hopefully encourage young orthopedic surgeons that it is very possible to start private practices and thrive. It's all about partnerships and making sure that you're creating the ultimate patient experience. I truly believe if you put your patient's experiences and needs and desires first, the rewards will come. In my area, we're the last private practice in Northwest Pennsylvania, and the physicians that sold to the hospitals are now extremely dissatisfied and wishing and regretting those decisions. I would say don't make quick decisions based upon pressures from hospitals and institutions. Try to maintain your independence as much as possible, and reach out to those around you that have been able to successfully navigate the waters of private practice and maybe look to partner with them as well."

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