For many years, private practice was a viable and attractive option for physicians who value autonomy and independence. In addition to having a great deal of control, there is no cap on physician compensation for owners of private practices.

Despite the drawbacks of high risk and little support, private practice was still a choice that many physicians felt passionate about. While it’s still viable today, many new physicians are leaning towards other practice options, which provide more stability and predictable income.

It’s common knowledge in the medical world that healthcare reform is impacting physician compensation and practice models in big ways. It’s one thing to read a general statement about it or hear a negative remark in passing conversation, but it’s another to look at cold, hard numbers.

A couple of weeks ago, CNN Money’s Parija Kavilanz posted an eye-opening story about the number of independent physicians who rely on government-guaranteed SBA loans to sustain their businesses. You can see the details in the chart above, which shows that distribution of these loans has increased “more than 10-fold since 2000.”


Kavilanz cites decreased insurance reimbursements, shifting regulations, increased business, insurance expenses and drug costs as the main financial stressors for independent docs. All of these are symptoms of the changing landscape of healthcare and the poor economy.

If you’re still determining your career path, there are several alternative practice options that share some of the desirable traits of private practice. If you value independence, work-life balance and flexibility, read on!

Multi-Specialty Groups: Stable Physician Compensation, Better Work-Life Balance

“What?!” you’re thinking. “How is a multi-specialty group a similar alternative to private practice?”

Really, it isn’t. But it could be if you’ve ever thought you wanted to go into private practice for the flexibility and work-life balance. Many people are attracted to the idea of working for themselves because they envision a life where they work less and have lots of time off.

In reality, people who work for themselves — doctors included — spend a lot more time working than employed folks. That’s because you’re a one-person show. You don’t just handle patient care; you probably also have your hands in billing, insurance paperwork and other administrative hoopla.

If you value work-life balance and flexibility, give Multi-Specialty Groups more consideration. Be sure to talk about your values with your employer to make sure you’re signing with an organization that’s a good fit.

Independent Contractor Positions: Semi-Stable Physician Compensation, Great Flexibility

Independent contractor physicians partner with hospitals or groups to provide service for a specific amount of time. Compensation is set in the contract, and typically remains stable until the contract is over.

A major bonus of independent contractor positions is that hours are usually incredibly flexible. You can work when you need and/or want to, and you also have the ability to write off business expenses.

This is probably the closest you can get to being a solo practitioner without actually starting your own practice. An added advantage is that employers usually have a support system for administrative work.

Locum Tenens Positions: Great Learning Opportunity, Flexible Schedule

Locum tenens, or substitute physicians, are physicians who work for an organization that schedules temporary assignments for doctors. You get to choose your own hours and the number of days you’d like to work, and the locum tenens organization plans your schedule.

One of the perks of such an arrangement is that you have the opportunity to travel frequently. You can also get exposed to a great number of organizations, making it attractive if you’re uncertain about your preferred work environment.

On the flip side, income isn’t as stable as other types of practice and you may have to travel to undesirable communities. However, locum tenens positions are definitely worth considering, especially if you’re a commitment-phobe when it comes to your job.

To read about other types of practice, visit Stage 2: Market Trends and Trials in the Adventures in Medicine Resource Library.

What do you think about the trend towards employed group practice? How does physician compensation play into your overall decision on what type of practice to choose?


Though the views expressed above are solely the writer’s, Southern Illinois Healthcare supports “The Dose with Dr. Goodhook” and is partnering with Adventures in Medicine to create an open, inspiring and insightful community for residents and physicians. Click here to learn more about ways that Southern Illinois Healthcare is making practice purposeful.