Private practice or employment? What would physicians choose if they could do it again 

Six physicians joined Becker's to discuss if they would choose private practice or employment

Question: If you were just starting your career as a physician, would you choose employment or private practice? What factors would you consider in your decision?

Editor's note: These responses were edited lightly for brevity and clarity. 

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. 

Zoher Ghogawala, MD. Neurosurgeon at Lahey Hospital & Medical Center (Burlington, Mass.): I would pursue an academic position in order to be involved in research and education as well as to be surrounded by partners to offer support when building a practice.

Joseph Sewards, MD. Chair of Orthopedic Surgery and Sports Medicine at Temple University (Philadelphia): If I were starting my career now, I would still keep an open mind regarding employment vs. private practice, weighing each on its merits, though I would be wary of being the new entrant in a private practice that is considering a partnership with private equity. There seem to be great rewards for established partners in a practice, but maybe not so much for the newcomers. They need to very critically evaluate the situation that they are entering, and I think that the established partners need to be cognizant of what things might look like to the new graduate looking to join them.

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.

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