3 pros and 3 cons of starting and managing your own private practice

Thinking of starting your own private practice? From business fundamentals to management issues and earnings variability, there are many factors to consider.

“A generation ago, 75% of physicians owned their own practice. Now, just the opposite is true: The vast majority of physicians are employed by hospitals, health systems, and private equity companies. This is unfortunate, as evidence [suggests] that physicians in private practice provide equal or superior quality [and] lower cost[s], and have lower rates of burnout. And patients love us. The care is more personal, and patients feel less like a case file lost in the bureaucratic maze of the healthcare system,” William E. Fox, MD, MACP, Immediate Past Chair of the Board of Regents of the American College of Physicians (ACP) and a partner at Fox & Brantley Internal Medicine in Charlottesville, VA, tells MDLinx.

The pros  

1. Physician autonomy

Dr. Fox is in private practice at Fox & Brantley Internal Medicine in Charlottesville, VA, and enjoys the freedom of private practice.

“Owning your own practice gives you tremendous autonomy. There is no boss, no ‘business-type’ administrator telling you how to run your practice, how much time you can spend with patients, what your hours should be, or what equipment you should buy,” he says. 

2. Practice aligned with personal values

“In private practice, you can design care around patients instead of system productivity metrics. And you can build long-term relationships and align your practice with your personal values,” Brittney Anderson, MD, a family medicine physician and private practice owner, tells MDLinx.

3. Establishing a legacy to be proud of

For some in private practice, the key benefit is the opportunity to build a legacy in their communities.

Dr. Fox shares this sentiment. “Perhaps most importantly, there is significant pride of ownership in having your own practice, which is not something typically associated with being an employee,” he says.  

But running a private practice is not without its challenges. The experts walso note that there are a number of potential downsides to private practice.

The cons

1. Start-up challenges

“Building a successful private practice isn’t easy. The early years require significant up-front work and responsibility. Physicians must learn business fundamentals that were not part of most of our medical training: cash flow, staffing, contracts, compliance, and operations,” Dr. Anderson says.

Dr. Anderson is also the host of Physicians Hanging a Shingle, a podcast focused on the practical aspects of starting a private practice and the mindset challenges physicians encounter during the process.

“The mental load can be heavy, particularly early on, and the learning curve is real. Private practice isn’t easy, but neither was organic chemistry,” Dr. Anderson says.

If you own a practice, what has been the hardest adjustment?

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2. No guarantee of a steady paycheck

3. Significant individual responsibility

“The lack of large health systems supporting a solo practice creates an environment where the private practice physician has to literally fight for every single contract, every policy change, [and] every reimbursement dollar,” Dr. Goldman says.

“The individual practitioner is responsible for everything involved, including the hiring, firing, staff management, ordering of supplies, [and] paying of all bills and accounts, and has the tremendous burden of running a small business in a difficult environment. It is not for the faint of heart or those unwilling to sacrifice time, effort, and energy to accomplish a successful practice,” Dr. Goldman adds.

The bottom line

While there are numerous challenges in operating a private practice, the experts argue that it can be hugely rewarding when done well.

“I do feel the pros outweigh the cons, [otherwise] I wouldn't still be doing it after 23 years,” Dr. Fox says. 

“While the salary may not be guaranteed and may in fact be lower than [that of] employed physicians, the autonomy over your job can make for a much more satisfying career with [a] lower risk of burnout,” he adds.