When I finished my training, I wish that I had known all of the options I could practice medicine.  Most of us categorized our options as either “academic” practice or “private practice,” but in reality, these two options only cover the tip of the iceberg.  Was my limited understanding a shortcoming of my medical training?  Perhaps.  I doubt that many medical schools back then actually had seminars on practicing medicine.  Since nearly all of my attendings belonged on faculty or clinical faculty, it would have been nearly impossible for them to round up a bevy of doctors from all walks of the medical scene.

The following is a compilation of some of the more common ways that doctors can practice medicine.  There are nuances in every category of medical practice that one would only truly understand after practicing in that venue, but here is a good introduction (along with my personal opinions):

Solo practice

Solo practice medicine is, unfortunately, not as popular for a number of reasons, but it is still a viable form of medical practice.  Generally speaking, one could either purchase a practice from a retiring physician or start from scratch.  That means buying your own building or finding a lease, signing up for insurance plans, and going at it.  There is always a learning curve to starting your own practice straight out of residency, but it could be done.  Obviously, some specialties in medicine may be more conducive to solo practice than others.

Pros:

• You can call your own shots.  That means taking all of the vacations you want.  Or you can work 365 days a year if you’d like.

Cons:

• Likely to require more involvement in the practice, including the business aspects of medicine.
• May require many years of long hours before business will flourish.
• Insurance companies in certain markets may not allow individual doctors to enroll in their plans if there are larger medical practices that are willing to take care of more medicine for less reimbursement.

Most of my classmates who decided to go into the private sector ended up joining a medical group.  These medical groups may be small, several-doctor organizations, or multi-specialty behemoths.  One of the perceived advantages of joining a large group is that they may better systems in place for benefits and that the patient volumes are more mature.  Having multiple coworkers also means that you will have more opportunities to collaborate and dissent.  Group practices may be able to allow doctors to achieve higher than average salaries for their field, given that there is likely some capitalistic motivation among the group’s members.

Academic practice

Academic medicine is synonymous with working for a university with teaching or research opportunities.  This may be the most “conservative” approach to many doctors’ first jobs since most of us trained at academic institutions (there are some training programs that are spin-offs of private practices).  Many of my classmates simply opted to remain on faculty at the institutions that they trained at after finishing fellowship.  There is familiarity with remaining at the institution that you spent the previous few years at.

Pros:

• Familiarity with an institution that you’re already working at.
• Good intellectual support system.
• Likely cutting edge medicine.
• Research support if you opt to conduct clinical/laboratory research.

Cons:

• Excessive familiarity with the institution that you’re already working at.
• Possibly poorly organized clinical support staff.
• Likely cap on earning potential.

Managed care practice

In recent years, there has been an uprising of managed care organizations, or those that have certain arrangements with health insurance to provide care.  Some healthcare systems like Kaiser Permanente have an insurance wing and a physician wing that work to cut costs and optimize care.

Pros:

• Optimized healthcare system. Robust benefits program.
• Stable and likely job security.

Cons:

• Physicians may be subjected to assembly-line care.
• May have a high volume of patients
• May have restrictions on how you can practice medicine.
• Not necessarily conducive to elective procedures.

Government / VA 

In some ways, working at a VA is sort of like working at a managed care organization except that the VA may even be more slow to adjust to anything. Many of us who have worked in VA systems may have felt that the clinics and operating theaters functioned incredibly inefficiently. That being said, to each his own. Working for the government does have its perks in set working hours and mostly easy pace of life, plus the fact that you are taking care of our country’s veterans.

“Smart Money, MD” is an ophthalmologist who blogs at the self-titled site, Smart Money MD.

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