From private practice to employment: considerations for physicians

The era of self-employed doctors is ending as more physicians move from private practice to employment. 

According to recent studies, about three-quarters of physicians are now employed by a hospital, health system, or corporate entity. And that number is growing every year. In 2022, over 90% of physicians accepting new positions will practice as employees rather than independent owners or partners. 

Are you an independent physician making a move to employment? Here are five considerations to kickstart your planning process. 

Tips for physicians moving from private practice to employment

Please note: this is general advice synthesized from other physicians and experts. If you have doubts, seek assistance from a mentor or qualified professional.

1. Know your practice options

The science of decision-making reveals that we solve problems more creatively when considering more than two options. Fortunately, you don’t just have two options: private practice vs. employment. 

The American Medical Association (AMA) points out that there are four contexts in which physicians can practice:

1. Solo practice
2. Group practice
3. An employee of a group practice, hospital, or healthcare system
4. An employee of an academic institution

The right practice setting is the one that best fits your unique professional needs and desires. While each has different risks and rewards, you can find value in each practice option. 

Consider what setting you want to work in as you move to employment. Have you thought about joining a group practice instead? Even if you don’t pursue this path, considering more than two options will help you clarify what you value and narrow your focus as you search for employment.

2. Accept tradeoffs

Most physicians accept that employment comes with some clear benefits and drawbacks. 

Employed physicians benefit from peace of mind: they have a stable paycheck, less administrative work, and more regular hours. The workday is more structured and predictable, and they don’t have to worry about running a business on top of seeing patients. In short, it’s easier to have a life outside their jobs. 

On the other hand, employed physicians miss out on the benefits of private practice. 

The biggest drawback to employment is the loss of autonomy. If you’re used to being in charge of your practice, being an employee can come as a shock. You no longer have a say in who’s hired or the clinic's hours. Your productivity might be carefully monitored and managed, and there might be limits on how long you spend with patients. 

Furthermore, moving from an entrepreneurial to a corporate culture can feel stifling for some physicians. And employed physicians earn less than their self-employed counterparts, on average. 

Physicians who have transitioned to employment give consistent advice: accept the tradeoffs. There will be challenges with any big career transition. Know that these are normal, and focus on making the most of your new opportunity. 

3. Take time to find the right fit

Taking time to find the right fit can minimize the culture shot that some physicians experience moving from private practice to employment. Be sure to vet prospective employers and carefully weigh different options' pros and cons before signing a contract.

The most critical advice is to talk to current staff physicians at any organization you consider joining. Ask about the work climate, productivity expectations, and organizational culture. Make sure you understand what your exact responsibilities and accountabilities will be.

Interview several physicians currently employed by the organization to ensure you get various perspectives. These conversations will help you determine if this employer is the right fit.

4. Be a team player

Two of the most important qualities employers look for are your ability to be a team player and provide good customer service. However, sharing patient care with a team is new for many physicians. 

Vet your future colleagues carefully to ensure they’re people you’ll enjoy working closely with. And when you do accept a position, focus on showing up as a team player. 

Being a team player isn’t neurosurgery, but it’s good to review best practices periodically. Remember to offer to help, listen more than you talk, celebrate team members’ successes, and communicate clearly. 

5. Take care of practical matters

There are many practical matters to resolve before closing your medical practice and signing a contract with an employer. Expect this process to take several months and require some long work weeks. Be patient, and take it step-by-step. 

First, remember to dot your i’s and cross your t’s when closing or transferring your current practice. In particular:

• Review your current contracts and notify your EMR and other vendors of your timeline. 
• Notify colleagues, professional societies, specialty boards, state licensing boards, and malpractice carriers. 
• Inquire about state-mandated responsibilities regarding patient transfers and record keeping. 
• Notify staff and administrators at all facilities where you admit or care for patients. 
• Notify patients in writing, following specialty society recommendations for procedure and timeline.

Next, perform due diligence before signing your new contract. In addition to confirming your salary, you’ll want to clarify contract terms, discuss ancillary benefits, know the termination provisions, and be informed of other legal issues that pertain to your new employment. 

As the trend toward physician employment increases, so have reported difficulties around treatment and referral inference, vague contract language, and compensation-associated performance metrics. In response, the AMA has developed six Principles for Physician Employment. These include advice for:

1. Addressing Conflicts of Interest
2. Advocacy for Patients and the Profession 
3. Contracting
4. Hospital Medical Staff Relations
5. Peer Review and Performance Evaluations
6. Payment Agreements

Review the AMA’s principles and ensure that you enter employment with a solid understanding and legal foundation to set you up for success.