Private Practice Owner vs. Academics

For the past 12.5 years, I've run my own private practice (along with my husband, but let's be real, he hates doing anything admin related) here in Hawaii. But before that, I was a salaried Attending physician at Boston Children's Hospital.

I've done both. Of course,  there are a lot of hybrid type models also, larger practices/HMO, which may fall somewhere along the spectrum. I know so many resident physicians struggle with deciding which path they want to take. There's such little exposure to private practice in so many hospital academic settings. It's something that must be sought out. So, here's my short breakdown of some key differences between the two. And, remember, your first job will likely not be your last. It's alright to pivot, course correct, to change your mind. Nothing is set in stone.

Salaried vs. self-employed

If you own your own practice, if you don't work, you're not bringing in income.  This affects decisions regarding how long to take for maternity leave and vacation leave. Employed academic positions typically have set amount of paid leave for both of those.  However, being a partner in a private practice can be more financially lucrative overall than academic salaries when you eventually factor in shareholder distributions at the end of the year. Of course, this is only if you run a lean ship and keep your overhead low.

Research

Typically there is paid time set aside in an academic setting for you to perform research and publish.  Though there are many private practice ophthalmologists who publish extensively, but they do so on their own time and the majority of it is clinical research.  Lab work is easiest in an academic setting.  But, there are no hard and fast rules. I have friends in other fields who are in private practice and is doing amazing research in their field including K-12 and other type of federal grants!

Management

Even if you have a very capable office administrator, as a private practice owner, you still need be able to understand the financial and Human Resources aspects of your practice, things you wouldn’t have to deal with in an academic setting. It's up to you to set the vision and direction for your practice - how you want to serve your patients, how you care for your staff. It's not easy work by any means, but it can be extremely rewarding to have a team which is truly committed to your goals. I spend about 8 hours a week on this aspect of the practice. Assessing the protocols of our office, staff mindset, our financial picture etc. If that holds no interest for you, then joining a larger practice as an employed doctor may be more in alignment with your interests.

Patient time

Most private practices spend more time with patient related care than academic settings, since your time isn’t being split with research or teaching. Again, no hard and fast rules, but this is generally the norm.

Teaching

In private practice, there aren’t as many opportunities for teaching as compared to academics. At Boston Children’s, I was in charge of Resident Education and interacted with residents and fellows daily. It’s something I miss about academics. Now, I teach my staff and I know they are grateful for that knowledge. There is a certain pride that comes with knowing why you're doing something, rather than just being a cog in the machine. Most of my techs can function at the level of a resident physician in ophthalmology! But, I really do miss teaching medical students and residents, I enjoyed it. It's part of the reason why I started Attending Lounge.

Autonomy  

Private practice does allow you the flexibility to practice medicine on your terms. It really works for people who hate feeling like they're a cog in the machine, being instructed on what to do by non-medicine administrators. I love being in charge of my own schedule. I love being in charge of the patients I see. I feel empowered and rewarded by what I do and know that if I'm ever feeling burned out, that I can make the change directly, without needing to consult administration. Need to cancel a clinic to go to my daughter's school performance? No problem. Feeling that I'm unable to deliver quality care because I've been double booked? Simply change my appointment scheduler. I love not being beholden to anyone else.

Call schedule

If you work in an academic setting, you will likely have residents/fellows who handle the majority of the calls. However, your call schedule will likely be dictated by your department. Some physicians I know who work at larger HMOs have to cover call for areas outside of their specialty. In private practice, you could theoretically be on call all day, every day, every year. And, how onerous this is truly depends upon your field and your relationship with nearby hospitals. Most eye issues are not true emergencies and can wait 12 hours to be seen the following day. For the few exceptions, we have a call schedule at the nearby hospital where we can send patients. Attending physicians are paid by the week to cover call, so it's win-win.

Job/income stability

Again, job and income stability has pros and cons for both private practice owners and academic settings. When you're your own boss, no one will fire you - but you if you're not an effective CEO, you might have to close your practice due to financial constraints. When you're employed by someone else, they hold the cards in terms of performance reviews, salary compensation and bonuses. For some, the thought of taking a chance on themselves is scary. For others, life myself, it's also invigorating (notice I didn't say it wasn't scary!)

Find out what drives you - what are your core values? When do you feel most satisfied?  After a day of research? Teaching? Or patient care?

Armed with that knowledge, a decision between private practice and academics will be easier to make.

If you're considering opening a private practice, download my free private practice checklist here.