Medical Practice Settings: A Quick Guide for Young Physicians

For a physician about to finish residency or fellowship, the differences in practice types may seem unclear. Each type of practice has its own positives and negatives, and some may be a better fit for your career needs.

If you are starting your job search, or at least thinking about your future practice options, you should be weighing the pros and cons of each practice type. Keep reading to see the upsides and downsides of each and how they differ from a residency or fellowship training environment.

Solo Practice

Pros

• Maintain autonomy and the ability to manage the practice to your own liking. If you want work extra to boost income, you can. If you want to work less but can find a way to remain solvent, you can.
• Less required staff to manage due to smaller overall volume of patients. You can hand pick your staff and make quick decisions about personnel.
• Significant potential for continuity of care due to familiarity with you, your staff, and the overall process.
• Taking over an established practice gives you an established patient base with an equipped office.
• Oversight of every aspect of the business gives you a firsthand education into the business of medicine.

Cons

• Business acumen is required because the practice’s finances rests solely on your shoulders. This is unless you consult with a practice manager, accountant, or other financial professionals.
• Handling administrative burdens and insurance coverage difficulties can cause headaches, especially with increasing regulations.
• High startup and overhead costs may burden you for a significant period of time before you can turn a profit.
• Purchasing an established solo practice may mean changing staff habits and implementing unfamiliar management styles.

How will it be different than training?

In a training environment, you can practice medicine without worrying about the supply of your patients. In a solo practice, you are responsible for accumulating and maintaining a patient base, especially if you are not taking over another physician’s practice. You will also lack the same day-to-day mentorship provided by your attendings in training and may encounter less interesting cases overall.

Group Practice – Multi-Specialty or Single Specialty

Pros

• Patient base is typically established due to flow of referrals from colleagues in the practice.
• Collaboration and camaraderie with fellow physicians can provide an environment for mentorship and learning.
• Working with other physicians provides increased coverage and gives you more scheduling flexibility.
• The potential for becoming a partner maps out a clear path for career advancement.

Cons

• Less autonomy due to higher prevalence of practice managers and needs of colleagues.
• Conflicts when it comes to dividing/distributing income. The responsibility is on you to make sure you are getting your fair share of profits. This is typically handled in the contract negotiation process.
• Less influence on office management and governance. Your suggested policies or changes could be ignored or take time to implement.
• Compliance with quality assurance standards and group utilization review create a more stringent work environment.

How will it be different than training?

Group practice will be more comparable to your academic training experience than solo practice will be, but you still face the challenges of private practice. The business aspects and management of the practice is still partially in your hands in a group practice setting. If the group is single specialty, then you will not have the same potential for encountering a diverse range of professional expertise. Also, as with solo practice, you will likely have less opportunities to see unique and challenging cases.

Employment Settings – Managed care organization, hospital-based specialties, VA Hospital, corporate health departments

Pros

• Specialization and sub-specialization possibilities. Large institutions allow you to find a niche.
• Potential for income guarantees. This is like a loan that is forgiven over time as you build a self-sufficient practice.
• Fewer hassles with billing. Dedicated staff can take much of the billing burden off your plate.
• Association with a well-known institution. This can be good for future career options outside of your current setting.

Cons

• No direct pathway to ownership. Career advancement is harder to define when employed.
• Limited direct control over practice finances.
• Restrictions on referrals. You may be limited to referring patients within your employer’s network, and may only receive referrals from within this network.

How will it be different than training?

One of the biggest pluses of this environment is your ability to further sub-specialize as part of your practice, which you would be limited in doing during a training program. You can also branch out into a wider variety of healthcare delivery roles, such as serving on governance committees or working in a nonclinical position.

Academic Medical Center

Pros

• Opportunities to teach and mentor trainees. This is especially popular for physicians who had a mentor that shaped their career and want to help “return the favor.”
• Plentiful opportunities for research and being on the cutting edge of knowledge within your field.
• Challenging cases and innovative techniques are more common.
• Exposure to multiple specialties increases your potential to broaden the variety of your knowledge.

Cons

• Dealing with bureaucratic inefficiencies can be major contributor to burnout.
• Pressure to publish or risk losing your position creates a stressful work environment.
• Filling gaps in care because of duty-hour limits. You are ultimately responsible for patient care when trainees are limited in hours.
• Advancement often requires geographical relocation.

How will it be different than training?

This is the type of practice you are probably most familiar with. As an attending at an academic institution, you will be tasked with overseeing trainees and will be responsible for their mistakes. You must also fill in the gaps for your trainees’ duty-hour limits and will be under more pressure to publish.