How to Choose the Right Practice Setting

Helping your community and making a difference in a patient’s life motivated you years before you started college. But, how much thought have you put into where you want to practice medicine? Choosing the right practice setting has a significant impact on the experiences you have as a physician.

EMPLOYMENT MODEL

Self-employed

If you do choose to be a self-employed physician, you’ll have complete control over your practice. That means you decide where, when, and how everything gets done. That also means that you have total responsibility for the business aspects of the practice. This sounds like a daunting task, especially if you employ others. Don’t worry, there are resources available especially for self-employed physicians, such as this article, “10 Reasons to Be a Self-Employed Family Physician and 10 Ways to Do It” from the American Academy of Family Physicians. The physician enterprise model is a self-employed model that is a compromise between being on your own and being an employee. It is an arrangement between a physician and a health system in which the system operates a medical practice at a fixed percentage of collections.

Employed/Hospital Employed

The number of employed physicians is rising and recently exceeded the number of self-employed physicians.¹ The reasons why physicians choose an employed position are many and varied. Factors like debt, income security, and more predictable work hours aren’t exclusive to employed positions but they are certainly more common. An employed position provides relief from many of the hassles of running a practice. However, this doesn’t necessarily lessen the physician’s nonclinical workload. While working for a hospital, you’ll have the opportunity to influence how that facility provides patient care.

Private Practice/Partnership

Let’s look at some of the benefits of private practice and some of the pitfalls. Joining a private practice doesn’t necessarily mean you’ll be self-employed. If you don’t start as a partner, there should be a written partnership track established. Regardless, while working for a private practice you may have more autonomy. You’ll have more control over how many patients you see and the level of care they receive. You’ll also have more influence on how the practice operates and the workplace culture. That means the onus will be on you to ensure that you and your colleagues have a satisfactory work/life balance. You will get to dictate how your patient relationships are fostered. Compensation is more flexible and, in your control. The concierge model of private practice is a way to have even more control over your practice. This model doesn’t work for everyone, but it is a very patient-focused method of practicing medicine.

TYPE OF HEALTHCARE ORGANIZATION

Independent or Solo Practices

Working for a small clinic that is part of a large healthcare organization will be different than working for a solo practice that isn’t partnered or affiliated with other practice organizations. The smaller the organization, the fewer layers of leadership there are, the better communication is throughout the organization. This affords more access to leadership and you having more influence in the way the organization is run. You also have more influence over workplace culture. Despite there being extra freedom in some aspects of a smaller practice you might find more restrictions in other aspects. Limited staff can lead to long hours and the need to wear many hats.

Large Health Systems

Because of the complexity of a large health system, you’ll be expected to focus on your area of expertise. Specialization can be a great way for you to become an expert in your specialty. A large network ensures a steady number of patients and an ample number of referring physicians. Allowing you to give and receive referrals and opinions with your colleagues making it easier to focus and learn. There will also be a wider variety of career paths available to you. You may change roles or locations without leaving the organization. The possibility for superior benefits and perks is greater in a large organization. Although there is usually less opportunity to negotiate. You may also find that it takes extra time to effect change or receive approval due to red tape.

Single Specialty

As the name implies, this is a practice that is made of physicians with the same specialty such as primary care or a specific subspecialty such as gastroenterology. This is common for some specialties but doesn’t work for all.  A single specialty practice may work closely with a large healthcare organization or be completely independent. This is a great way for physicians to share resources needed to manage the additional tasks associated with running a practice and provide weekend and after-hours care. It can also help lower marketing and other overhead-related costs.

Multi-Specialty

If large enough, multi-specialty groups can partner with many different health systems or they may serve one community. Depending on the size of the group the physicians within can become very specialized. If you’re a pulmonologist in a large multi-specialty group, you could choose to only treat asthma patients. The same resource sharing benefits of a single specialty practice apply. The difference with multi-specialty is the added convenience for patients and the ability to provide more personalized patient care when seeing multiple physicians.

Clinics

Clinics focus on outpatient care and unlike hospitals, most of the patients have scheduled appointments and have a history with the facility. Clinics typically operate on a “9-5” type schedule which means regular hours that can include weekends but typically don’t include holidays. Due to a consistent flow of patients and fewer opportunities to increase your patient volume you might have limited opportunity to greatly increase compensation. It could be more beneficial to negotiate for quality bonuses or profit sharing.

Hospitals

Hospitals focus on inpatient care. They are always open and accept patients in all conditions which makes for a fast-paced environment. This environment makes hospitals a good place to gain experience quickly. Because of the demands of working in a hospital, the compensation is typically competitive and the opportunities for production and quality bonuses exist.

MARKET DEMOGRAPHICS

Rural

Being a physician in a small rural practice, you will quickly become a key member of the community. As one of the medical professionals in the area, you’ll be exposed to a wide variety of cases which leads to an elevated skill set. Spending extra time with patients is typical as well, limited access to care requires a need to be thorough and extra focused on patient education. The economic benefit for a physician in a rural area can be very high because of your compensation and the low cost of living. You will generally find competitive compensation and benefits at rural facilities because of the great shortage of physicians. Make sure you’re ready for the rural lifestyle by spending time with members of the community before signing a contract. The downsides can include feeling like you’re always working because you’ll frequently see your patients during your personal time. You might feel like support is lacking because the next closest healthcare facility may be hours away.

Metro

Practicing in a metropolitan or suburban market gives you access. There is more diversity and higher patient volume. You will have more control over the cases you see, and you have the ability to ask for consults. There are also more practice and growth opportunities without relocating. All this access comes at a price, the cost of living is typically higher and there is added causes of stress like traffic and the hustle and bustle of daily life.

How to Choose What Fits Best

When deciding on your next practice setting make a pros and cons list. Think about the lifestyle that you want and the needs of your family (if you have one). Think about your career goals and what your next opportunity needs to have to achieve those goals. You can use our physician salary calculator to compare compensation, benefits, and cost of living of each opportunity to see if your financial needs will be met. Your retirement planning and financial status should be part of your list. It’s hard to know what practicing in any setting will be like until you get to experience it firsthand. This is why our recruiters travel to the facilities we partner with to get to know the community and the organization. They are an excellent source of information and are happy to answer questions.

1. “The Physician Employment Trend: What You Need to Know” AAFP 2015. https://www.aafp.org/fpm/2015/0700/p11.html