'Where Do I Fit In? What's the Right Job Situation For Me?'

Shelly Reese


September 17, 2012

In This Article


The type of practice setting you choose is a seminal decision affecting everything from your salary and relationships with colleagues to the hours you work and, ultimately, your attitude toward your career.

What's more, given the rapid changes taking place in the healthcare arena, selecting a practice setting is no longer a decision with which only final-year residents must grapple. Increasingly, financial pressures, government regulation, and technological and administrative demands are causing physicians of all ages and career stages to re-evaluate their practice choices. But the process isn't easy.

"The truth is that there's no 'right' practice," says Oklahoma family practice physician Russell Kohl, MD, who has worked in several different practice environments. "There's just the 'right' practice for you."

To help you find what's right for you, we've examined the pros and cons of a number of practice types. Take a look at these and see which one suits you best.

Can You Handle the Challenges of Solo Practice?

There are a few prerequisites for physicians who want to fly solo: nerves of steel, adaptability, and an entrepreneurial streak.

Solo practice is really for "someone who is very independent and wants to be in control or for someone who is a very high producer who thinks they can do better on their own," says Rob Scroggins, a principal with Clayton L. Scroggins Associates, Inc., a Cincinnati-based practice management consultancy.

Only 1% of final-year residents surveyed last year by Merritt Hawkins, a physician recruiting firm, say they'd like to practice medicine on their own. That's down from 8% in 2001. The realities of today's economy and healthcare market -- heavy student debts, limited access to credit, downward pressure on reimbursements, and increased staffing and administrative costs -- partly explain the decline, while the very nature of solo practice with its long hours, small business headaches, and inherent uncertainty fills in the remaining blanks.

Given the obstacles, why would anyone want to go into solo practice?

"Freedom," says Dr. Kohl, who happily practiced on his own in rural Vinita, Oklahoma, before joining the faculty at the University of Oklahoma School of Community Medicine in 2011. "If you don't like the way things are going, you change it. There's no committee to go to. If someone discovers a new and better way of doing things, you can implement it tomorrow and your patients can benefit by next week."

While Dr. Kohl believes in the viability of the solo model, he says young doctors coming out of residency are looking for employed positions because "they simply don't feel equipped to tackle the challenges of private practice" and because they haven't been exposed to independent practices. "They don't think they have options."

As the move toward hospital employment gains momentum, some subspecialties, such as ophthalmologists, dermatologists, and allergists, are better positioned to remain independent than others, says Scroggins. Primary care practices, if they want to continue flying solo, may need to adapt to market pressures by adding new services such as weight management, forming strategic alliances with hospitals, or moving to concierge medicine.