Types of Physicians' Practices

After one obtains an M.D. or a D.O., works as an intern, and completes resident specialty and subsequent fellow subspecialty work, he or she has several options as to which type of practice he or she would like to enter. One may enter private practice, become a hospitalist, join a corporate clinic, or join a government/military organization.

Private practice is a common option that can be further subdivided into solo and group practice. Solo practice is exactly as advertised, practicing without partners or employment affiliations with other practice organizations. This type of practice is becoming less common on the medical scene and is characterized by a small staff and use of family members as part of the staff. The greatest advantage of this type of practice is autonomy; your input and opinion will always be paramount, and your suggestions will never be ignored. The drawback is that limited staff makes for a heavy burden. The obligation of taking call when you need time off can affect the quality of your life. Furthermore, solo practices face the risks of financial setback due to lack of referrals and a small patient base as well as lost income due to illness or vacation.

Group practices are typically divided into single-specialty and multispecialty practices. Single-specialty practices are usually characterized by the presence of two or more physicians providing patients with one specific type of care. Advantages of single-specialty group practices include increased financial security and a controlled lifestyle. Decision-making is shared, which is a source of potential conflict, in comparison with solo practice. Multispecialty group practices offer various types of medical specialty care in one organization. Advantages to this system include the ability to provide multiple patient services at one location and the ability to offer attractive compensation packages (salary, benefits, vacation). Drawbacks include lower salaries that reflect fewer working hours as compared to single-specialty practices and decreased autonomy and decision-making ability as a result of a larger group.

Hospital-owned practices are becoming a more common option for established as well as new practices. Advantages of this system include the ability to assume more risk and a large referral network of practices. As with large multispecialty practices, physician autonomy is diminished. Nighttime hospitalists are often referred to as nocturnalists. In this system, many hospital specialists provide services but are not admitting physicians, such as anesthesiologists, radiologists, pathologists, and radiation oncologists. Corporate multispecialty clinics, such as Kaiser Permanente, are similar to large, multispecialty group practices. Financial risk is minimal, as is the paperwork burden typical of physician-owned groups. The biggest disadvantage is loss of autonomy is running the practice, compliance to rules and regulations created by other individuals, and small productivity incentives. Lastly, government/military occupations, such as those available through the Veterans Health Administration, are another alternative for practicing physicians. The Veterans Health Administration is involved in the operation of numerous VA outpatient clinics, hospitals, and medical centers.