Private Practice or Hospital? A Choice of Autonomy vs. Reach

Physicians who prioritize leadership opportunities in the workplace should weigh the pros and cons before deciding which career path suits them.

For physicians who are ready to pursue leadership positions, the environment they chose to work in can have a major impact on opportunities available to them. Does the entrepreneurial freedom of private practice afford more room for growth, or would a hospital institution have the infrastructure and resources needed to support better leadership training?

Manoj Jain, MD, MPH, moved to Memphis, Tennessee, in 1995 to start his private practice treating infectious diseases. Although Jain was attracted to the independence, he quickly realized the influence he made in his private practice alone could go only so far.

In 1999, Jain joined a local quality improvement organization and took on a more administrative role, examining epidemiological data and becoming more plugged in to trends in health care on a larger scale.

“Private practice has the element of what every doctor goes to medical school for, which is being able to treat patients,” he says. “There is a tremendous amount of satisfaction in that, but it doesn’t allow for a broader system change or a broader perspective in managing the process by which we care for patients in a health care system.”

According to a 2009 Governance Institute white paper, Leadership in Healthcare Organizations: A Guide to Joint Commission Leadership Standards , hospital leadership typically consists of three primary groups: a governing body, a chief executive along with other senior managers, and leaders of the medical staff. The responsibilities of each vary, and leaders can occupy more than one position, facilitating opportunities to gain skills in more than one realm of administration.

Private practitioners often find their place in the third group, allowing them to influence broader change while still maintaining their commitments to their businesses. For many physicians, leadership opportunities bring fulfillment that clinical practice alone does not provide.

“The members of the governing body of a healthcare organization face both extra challenges and extra rewards,” according to the paper, which serves as the Joint Commission’s leadership standards. “The rewards can not only outweigh the challenges, but can be fulfilling to a degree not often experienced in other endeavors.”

Though a practice facilitates a sense of autonomy for many physicians, there are typically less prospects for advancement than at a larger hospital institution. There is also the issue of lack of time.

“When you are a doctor, you are in the service delivery business from patient to patient, and you just don’t have the time to sit back and reflect as much as you should,” Jain says.

Jain insists that private practitioners interested in expanding their influence can certainly do so by joining boards and engaging in other leadership activities. However, he says, it will typically be more difficult for those physicians because they may not be as privy to changes in the larger system.

Jain says physicians who choose private practices face other challenges as well.

In a 2012 Washington Post column by Jain, he refers to himself as “an endangered species,” after observing practices being purchased by hospitals across the United States. The trend has continued as private practitioners appreciate the benefits of the financial security and resources available in a hospital setting.

“Hospitals are looking for better control over doctors, and that’s why they buy practices,” Jain says, “and doctors are looking for less administrative hassle, and that’s why they tend to sell their practices.”

Physicians who prioritize leadership opportunities in the workplace are likely to find options that suit them in either a private practice or hospital environment. However, they are faced with a choice between autonomy and reach.

Though private practice naturally facilitates the flexibility to be your own boss and make decisions about your business — a characteristic many leaders are drawn to — the impact physicians can expect to make as a private practitioner is typically on a much smaller scale than as an administrative role with a larger organization.

Hannah O. Brown is a freelance journalist based in Florida.