I am a PGY3 seriously considering PP. I will list my pros/cons below, both to give some insight into my own PP concerns and see what those with more experience have to say about it:
PP Cons:
-Lack of experience with the model: I have been in academia pretty much forever, I know it well (and know I enjoy it). That doesn't hold for PP.
-I have heard insurance is a hassle. If I get paneled on 1-2 insurance plans I don't know how much stress that will add to life. I also don't know if a newly minted attending has the pull to fill a cash practice.
-Isolation. I love working with colleagues and I like to teach. Will PP mean the only people I see at work are patients?
-Income uncertainty. I am totally fine with a $130-200k salary, I'm not shooting for the stars. I can guarantee that by signing on even in academics after graduating, I'm not sure what the market is like for PP in my city and how long / how much effort this salary range might take.
-Possible lack of variety. I'm not sure how you can weave seeing patients in with other opportunities like research, consulting, etc. Five days a week of a full outpatient schedule might end up wearing you down.
-Pager coverage. If I do solo, I have to find a way to get coverage or I'm it 24/7.
-It's probably hard to become a thought leader from PP (v academics).
-Roots. It would be a lot harder to leave and restart a PP than to leave a salaried position for another.
-If the healthcare landscape changes and I want to go back to academics, this is probably tougher than the other way around (leaving academics for PP).
-Losing my awesome access to pretty much every journal out there via the affiliated med school.
-Less exposure to seriously medically ill individuals who would probably need a clinic approach.
-How lean can a practice run? I would like to avoid hiring front desk staff etc, doing my own scheduling and billing, but I'm not sure if this can work. If I have to hire staff, I have to manage staff (and the per hour pay rate would take a real hit to do so).
-Benefits. You cover your own health insurance, retirement, etc etc. This should factor in to your income math.
PP Pros:
-Scheduling autonomy. I can work four days a week if I want, or do evening hours, part-time when it fits with my life, or leave schedule gaps, whatever. That flexibility probably isn't available in most salaried positions. I can also choose my practice location.
-Time with patients. If I feel psychotherapy is indicated I can do and bill for that, if short med management is indicated I can do that too. I would not have my practice style dictated by an employer.
-The focus is really clinical, allowing a lot of exposure to (and learning about) a range of psychopathology. I think this would be slowed down in an academic environment given the multitude of other responsibilities.
-Fun! I think running a small business adds a layer of complexity that would be engaging and challenging.
-Less direct politics (I'm sure networking is part of a successful business, but I would not for example have to work under a bad boss)
-Income potential: once you start hiring others (LICSWs, psychologists, other psychiatrists) and taking on additional responsibilities as they arise the income ceiling can lift significantly.
-Higher functioning patients (though this can be a con as well)
So basically I imagine a lot of people are thinking through a list of pros/cons similar to mine and end up going for the safer bet. I would love more input though about what PP life can look like, and how those who made the leap did so!