Hospital Employment vs. Private Practice: Pros and Cons

For any physician, making a decision between hospital employment vs. private practice takes a little thought. Each employment setting has both benefits and disadvantages, so you’ll want to determine which of the two offers more of the former in your situation. For example, if you have significant debt from student loans, your salary may take precedence over other factors. Your choice basically boils down to finances, autonomy and administrative work. 

Money Matters
Your potential starting salary in private practice may be less than what you could earn by working for a hospital, because a private practice makes its money on net collections. It takes time to build up significant income. Another consideration: when you work for a hospital, you’ll have to go through regular salary and contract negotiations. In addition to salary, you should consider other potential benefits like retirement, health insurance and the operational costs of private practice. If you choose a non-profit hospital in a medically underserved area, you may be eligible for loan forgiveness, which can make a significant contribution to your personal bottom line. Other issues: relocation assistance or a sign-on bonus.

Autonomy
Let’s face it — when you work for yourself, you call all the shots. That includes both patient care and operational management decisions. Working for a group physician practice means you’ll have more of a voice than working for a hospital. For some physicians, not having to make some of those decisions sounds like a terrific idea. But it can also mean that you have to live with the organization’s EMR or clinical practice guidelines. The support staff you work with report to the hospital, not you. If the organization adopts new practice or quality metrics, you’ll need to meet them even if you don’t agree with them.

Operational Aspects
As the boss, or one of the bosses, you’ll have to worry about things like payroll, human resource decisions, payor contracts, marketing and capital outlays. If you and your partners own your office building, there will be mortgage payments and maintenance issues. When you work for a hospital, someone else handles all those details. On the down side, it could mean you have to share an office or support staff, and if the organization decides to change a service line in which you practice, you may not be able to influence the decisions.

Other Considerations
One thing a hospital offers that you don’t usually find in private practice is the opportunity for shift work. Say you have young children, and want to adjust your work time to coincide with their schedules, or at least minimize conflicts. In a hospital specialty like emergency medicine or as a hospitalist, shift work is more likely to be an option. Shift work may also mean that you don’t have to take call.

The Bottom Line
Before you leap into either hospital employment or private practice, do your homework. Talk to colleagues on both sides of the equation, including recent graduates and experienced physicians. Ideally, find a few who have experience in both environments. Become familiar with the legislative and quality incentives looming in the future and consider how they may affect your practice style in both environments; remember, hospitals will be held more accountable for many of these issues. Consider potential reimbursement trends, such as a switch from direct production to ancillary services. Identify your negotiating strengths. For example, primary care physicians may have a lot of leverage right now because of shortages and high demand in that specialty.

Elliot Health System (EHS) is the largest provider of comprehensive healthcare services in Southern New Hampshire. Check out our current job opportunities to see if you’re a match today!