Private Practice vs. Hospital Employee

Discussion in 'Young Ophthalmologists' started by Brathmore, Nov 28, 2018.

  1. Brathmore

    7+ Year Member

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    Hi All,

    I'm trying to make a decision about jobs. One is with a small private practice; another offer is as an employee of a community hospital. Can any of you offer insight about your experiences? Some of the factors I'm considering include:

    - Compensation
    - Autonomy (vacation, setting your own schedule)
    - The advantages/disadvantages of running your own practice.

    The compensation the hospital is offering is quite generous for a newbie like myself; however, I worry about the earning potential, and whether the terms will change much in the future.

    Is it a given that, if working for a hospital, you'll be working 5 days a week, earn less, have less vacation, etc. than in private practice?
     
  2. Rhexis

    Physician 2+ Year Member

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    Depends on your situation and where you want to work. Yes working in a hospital will give you less vacation, less autonomy, and less pay than a BUSY private practice. However, if you go into a saturated market and try to go solo or small group, you may not be able to build a big enough practice to make more than your friends working at the hospital. I have plenty of friends in saturated markets that sold out to a hospital and now make more, because volumes are higher because they're being fed patients by the hospital.

    You'll see people on this forum that have made both situations work. I tried a very small private practice. I wanted higher pay, autonomy, etc... I dreamed of being an owner in a private surgery center, and having the freedom to do what I wanted, when I wanted, and make a lot of money. My dreams turned out not to be reality. I found it incredibly stressful. I won't go into reasons why, but it involved low patient volumes in a saturated market, overhead concerns, and a very difficult partner situation. I've joined a hospital, and while I know I'll make less in the long run, but you can't put a price on the amount of stress relief I've gotten from leaving the situation I was in. I probably would have been just as happy joining a larger group that was busier, but I'm happy where I've ended up. You may talk to similar people who hated working in the hospital and love private now.

    Long story short, depends on your situation. If you're going into a non-saturated area, I'd roll the dice and go private. Going into a super-saturated area? You better join a group with an excellent marketer, or become excellent at that yourself. You better love the business side of it, I certainly didn't. You can make it work but it'll be rough at first. It's definitely not for everybody but certain people on this forum (Solo Building Blog) have certainly made it happen.
     
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  3. Brathmore

    7+ Year Member

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    Thanks Rhexis!
     
  4. schistosomiasis

    schistosomiasis Junior Member
    Physician 10+ Year Member

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    Good post by Rhexis in saying different career paths can work out very well for different people, and that there are advantages and disadvantages to every model.

    I ageee with his (or her) intelligent comments and want to add the following:

    1. Too many times have I seen a junior associate be stressed about the business side- because the senior partner was taking away their lunch. Many of these folks “magically” became better businessmen when they went solo. Many of these friends are in saturated areas and actually busier when they were in a group, because they were competing with senior partner for cases.

    Where I am there’s another doc across the parking lot and the buggiest group in town that sold to private equity is a block away. I’m doing just fine. I spend $1200 a year on marketing and rarely go out to meet referring docs.

    You don’t need business experience or outgoing personality to succeed: Do I need a MBA or business experience for my solo medical practice to succeed?

    2. Surgery center ownership is no guarantee of riches. My shares tanked 40%. Because some high volume surgeons left. It will take years until I break even on my initial investment. If you want to start ASC from scratch it is a lot of work, and no guarantee to make you rich, or break even.

    3. For me, it was stressful to work in a group having some clueless administrator tell me what to do when I knew they were wrong and i could run it better. I’m the type who wants to reap the rewards, or live with the consequences of their decisions. To me (but not everyone) it is MUCH less stressful to run things my own way. Had i stayed with my group, I would’ve got burnt out and quit ophthalmology. Also if you work for a hospital like I did, less likely will independent docs in the community refer to you.

    4. This poster feels the same way as me expect about Kaiser: Why I Left Kaiser (and Why You Might Want To) - OphthoQuestions

    5. Even if you are making less in the hospital (I am making less solo compared to my employed gig but that will change next year), you can still get rich if you simply save 20% of your income and take advantage of every tax advantaged account.

    What to do with your first $50,000

    If I were a family doc earning $200,000 a year, i would still easily become independently wealthy. It would just take me longer than a ophthalmologist earning $400,000 a year or upwards.

    The whole point of getting rich isn’t to buy a lot of stuff you’ll never use. It’s to be able to do things on your own terms. If i decide to cut down to part time for my solo practice to spend more time with family, I can. Would the hospital administration let you do that?

    Once you have enough money, freedom is priceless. The whole time I was working at my employed gig, I was thinking “I would happily give up $100,000 of my salary to make these people go away”

    I went solo for the independence, not to make a lot of cash. The fact that my overhead is so much more efficient is a bonus. Even in saturated areas you can make a good living seeing 12-15 patients per day. Dr. Choi Version 2.017

    6. Here are some more tips for those of you in job search: Ophthalmology resident and young ophthalmologists transition to becoming an attending: blog posts
     
    #4 schistosomiasis, Dec 6, 2018 at 8:36 AM
    Last edited: Dec 6, 2018 at 8:51 AM

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