Whether you are pondering the next move in your career as a young physician or preparing for the job search in your final year of residency or fellowship, you may find the process of evaluating practice options overwhelming.
An AMA STEPS Forward® toolkit, “What to Look for in Your First or Next Practice: Evaluate the Practice Environment to Match Your Priorities,” offers young physicians a breakdown of available practice settings and how they differ.
One arena of the decision that is covered in depth by the toolkit is employment status. Here is some insight into the potential pros and cons of working in private practice, group practice and hospital settings.
The perks of being the boss
The most autonomy—and certainly the most risk—comes with being the owner of your own solo practice. In this setting, you are essentially your own boss. You run the books, control personnel decisions and manage your schedule as a solo physician.
“If you're looking for the most autonomy, then that's the way to go,” said AMA member Stephen Parodi, MD, who is executive vice president of external affairs, communications and brand at The Permanente Federation. Dr. Parodi also is associate executive director of The Permanente Medical Group and vice chair of the AMA Integrated Physician Practice Section Governing Council.
Dr. Parodi spoke of watching his father run a solo dental practice when he was growing up, and he believes the health care landscape has seen considerable change.
“It's a lot harder—at least looking at the practice environment across the country—to go hang your own shingle nowadays, considering the amount of regulation, management and overhead,” said Dr. Parodi,.
Find out about the AMA Private Practice Physicians Section, which seeks to preserve the freedom, independence and integrity of private practice.
Trading some autonomy for security
Partnering in a group practice generally offers a measure of autonomy that isn’t available to employed physicians, but it isn’t quite the same level of freedom in decision-making as those who work in a solo practice.
The Permanente Medical Group is the largest such group in the nation, with nearly 9,800 physicians working in a multispecialty practice. Dr. Parodi has found that day-to-day clinical care is still up to the individual physicians working in this arrangement while the management of the business is evaluated on a larger scale.
The Permanente Medical Group is a member of the AMA Health System Program, The AMA Health System Program provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
“Every practice has financial risk, but large groups are able to decide how to distribute it,” Dr. Parodi said. “Business-related decisions are more personal if you are in a smaller group practice setting and you are directly running it. However, we certainly have conversations about how to ensure our practice clinically and financially performs. There can be more security in being in a large group practice.”
Find out how the AMA Young Physicians Section gives voice to, and advocates on, issues that affect doctors under 40 or within the first eight years of professional practice after their training as residents and fellows.
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The lowest-risk option
As a hospital-employed physician, your level of risk tends to be the lowest. That is part of the reason why employed physicians now exceed those who own their practices, according to data the AMA collected from 3,500 physicians in the 2022 Physician Practice Benchmark Survey. Along with that, however, your employer sets the framework of your employment, and what that looks like is going to vary.
While the tradition has been for less autonomy in an employed setting, the current labor market might be changing that.
Alexandra Ristow, MD, is the lead primary care physician at Patina, an in-home and virtual care primary care practice for seniors in the Philadelphia and Charlotte areas. She wrote the AMA STEPS Forward toolkit on choosing practice settings.
“You don’t know until you ask what level of autonomy might be on the table,” Dr. Ristow said. “Especially now, the market is so tight that people are much more open to thinking creatively about what elements of autonomy are afforded to you and what that might look like.
“So, for example, we see many more people integrating some element of virtual care into their practice, which may, in some cases, potentially allow you to work from home. A few years ago, many people would have laughed at you if you asked for that. People would take it seriously now in this job market.”
The AMA provides the resources and support that physicians need to succeed in private practice. These include the “AMA STEPS Forward Private Practice Playbook” (PDF), which is based on qualitative research into physician interest in private practice and the management needs for operating a private practice, and the “AMA Thriving in Practice” podcast, with tips from experienced private practice physicians on navigating pain points and other issues.
Learn more with the AMA about understanding physician employment contracts.
