Things to consider before you choose a practice setting

AMA Wire
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Residents and fellows who are coming to the end of their training are probably thinking: What next? First, assess your practice options.

Choosing a practice setting ultimately will be based on your unique combination of needs and desires, but there are some things to know about different settings that may help influence your decision.

  • Solo practice. Starting or purchasing your own practice will give you the utmost control and autonomy, and you’ll need have strong business sense to successfully manage the practice. While this option offers the most freedom, it also can be the most difficult, as administrative burdens, high startup and overhead costs and unpredictable work hours all fall on your shoulders.
  • Group practice. Entering into a single-specialty or multi-specialty group often means gaining an established patient base, and you’ll probably share patient responsibilities. These settings may offer more predictable work hours and income, but on the other hand, also limits your autonomy. In group practice, you may have less of a voice in income distribution, office management and other practice issues.
  • Hospitalist practice. Physicians who want to focus on the medical care of hospitalized patients may find they enjoy the shift-based schedule, which can be more predictable and flexible. Practicing as a hospitalist often means being busy on the first day of work, because the hospital is your patient-generating stream. However, the shift work can be long, and can result in a schedule that requires working more nights and weekends. Hospitalists also have limited patient continuity of care.
  • Academic medical practice. This setting offers opportunity for research and being at the cutting edge of knowledge and skills, including taking on the toughest patients to diagnose and treat. Meanwhile, the complex leadership and bureaucratic structures at academic medical centers can be discouraging, and the resident duty-hour limits that governed your work hours as a trainee often mean attending faculty must fill in gaps in patient care.
  • Employment. Joining a managed care organization, hospital-based specialty, corporate health department, public service or other employed agreement often means income guarantees and set hours. Employed physicians typically don’t deal with billing and administration and inherit an established patient base. At the same time, employed physicians may have little, if any, ownership interest or control over the practice. If you’re interested in employment, read tips that can help you negotiate the job hunt.

Use the AMA’s Succeeding from Medical School to Practice resource for more information to help you decide on a practice setting.

Follow the “Life After Residency” series at AMA Wire® for more things to consider as you approach the end of your residency.

Add your voice to this conversation: What’s next for you in your career path? What are you considering before you make decisions about the next phase of your career? Leave a comment below. 

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For physicians who are going into private practice, talk to various members of the medical staffs of the hospitals in the community to get a feel for the medical staff attitudes. Talk to members of the same specialty if possible. Obtain a realtor who will show you the appropriate places to live. Visit banks to see what their attitude is. Consider how you are going to get patients for your practice. Take your wife if married.
Electronic practice will favour the patient health morally and boost the siprit of physician to work in hormony.
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