Private practice is appealing for many physicians, and we're big fans in our communities. It generally provides more autonomy, control over your lifestyle and earning power, and the ability to build something that you own. Of course, as with any decision, it has its pros and cons, and it's not for everyone. Private practices can vary a lot in how they're operating, what the group culture is, and how they design contracts. Finding a group that lines up with your goals can be daunting, but it's worth taking the time to find the right fit! This page goes over some of the numerous considerations to take into account when looking into joining a private practice, and how to figure these out on your interview day.
As always, please remember that we are not in the business of giving personalized advice, and you should consult relevant expertise before making any decisions on the basis of what you read here! Some links on this page may be monetized or reference monetized resources, which support the group at no cost to you.
We have compiled a primer on contract negotiations to help you negotiate not just for what you're worth, but to make sure you are protected.
To help empower our physicians to know their worth, we've also compiled a salary and negotiation database with thousands of data points across the country, as well as an on call information and negotiation database. Visit the Favorite Resources section at the top of our contract negotiations page for the links to the most up-to-date versions.
We offer an attorney database that includes contract attorneys if you need a professional evaluation before signing your agreement. We do recommend this, as you better believe the private practice will have a legal team that is looking out for their best interests (which is a good thing; you wouldn't want to join a practice that didn't protect itself).
Interviewing at A Private Practice
Interview days are intimidating! You've got so many things to accomplish in a relatively small amount of time. You want to make a good impression, learn as much as you can about the practice, and assess if it's a right fit for you. It's easy to get caught up in just wanting to get the job offer, but remember, they aren't just interviewing you for the position - you are interviewing them as well. This is what you've worked so hard for, and you want to make sure the practice meets both your personal and professional goals. Here are some things you're going to want to make sure you figure out through carefully selected questions. Prepare ahead of time and find out the answer to as many of these questions as you can yourself, so that you can be intentional about how you spend your time on interview day.
The 10,000 Foot View
Working for a private practice, especially a small one, can be similar to marrying into a new family. You want to make sure your visions mostly align and that the in-laws won't drive you up the wall.
When evaluating different options, begin from a board perspective to make sure the opportunity isn't a fast track to burnout and frustration with the environment. Some questions to consider:
What is the practice’s philosophy on patient care and growth?
What is the current ownership and management structure of the practice?
What is the work-life balance among the doctors in the practice?
What is the practice's philosophy on physician led care?
What is the practice's view of private equity?
Are they insurance based or cash based?
How closely knit are the partners in the practice?
Does the practice have close ties with a particular hospital system or an academic medical center?
Are there opportunities for partnership? Any tiers to partnership?
Take some time to figure out your own views on these things and how much each matters to you if you haven't already, as a lot of these factors will impact your long term happiness with the practice.
Narrowing Your Focus
Questions to Ask To See if it's the Right Job for Your Personal and Professional Goals
Once you've assessed the big picture and feel like the opportunity is a good fit, you can start to narrow your focus to how you, specifically, will fit into their environment. Some examples of questions you may ask yourself or them when comparing different options:
What does a typical day at the practice look like?
How well do you fit with the other physicians in the practice?
What are the outside of clinical work responsibilities that you will have in regards to operation of the practice? Are there committees you will be on? What is your opportunity to be involved in leadership?
How does vacation time, sick leave, CME time, and parental leave work?
Are the staff happy at the practice, or do they feel overworked and underpaid?
What does the bonus structure look like, and how likely are you to hit it?
What is the path to partnership in terms of timeframe and likelihood of getting partnership?
Are they looking to hire you to grow their practice, or are you being brought in as a replacement? By asking key questions, you can ensure that the private practice you are considering has realistic expectations for your performance from the start. It also gives you a baseline on their structure and plans to make sure you have realistic expectations of how much support and resources they will be giving you.
Questions to Ask for a Growth-Based Opportunity
Some questions to consider when you're being brought on as a new employee to expand a service area are:
What is the growth potential?
Is there a waitlist for patients to be seen?
Who are the competitors in the region?
What kind of resources will the practice provide for you to be successful?
What are the marketing strategies utilized to advertise your addition to the practice?
What is the current patient volume of the physicians who are currently at that practice?
What are the ranges in collections for the physicians at the practice?
What is the age distribution of the partners? Does this help you or hurt you in opportunities for growth or what kinds of decisions they are likely to make for the future of the practice (for example, more senior partners might be more likely to favor lifestyle or selling to private equity, but also they might mean there's more opportunity for you to scale up as they scale down)?
Questions to Ask for a Replacement Opportunity
Some questions to consider if you are replacing a retiring physician or one that is leaving the practice:
Why did that person leave the practice?
Were there others who also left the practice? For what reasons?
How are the patient volumes being distributed from the retiring physician?
Questions to Ask to See How the Practice is Run
What is the long-term stability of the management and administration? What is the process by which the practice makes decisions?
What say do employed physicians have in how things are run?
How many of the previous employed physicians were offered partnership? How many of them took it?
What is staff turnover like?
Is there flexibility to create the schedule that works for you (requirements for # of hours or days a week, start and end times, vacation time, etc)?
What are practice expansion plans?
What are ancillary revenue streams that the practice has?
Once you've completed the interviewing process and decide you want to move forward, attention shifts to the offer itself and the contract negotiation process. The contract for the employed physician in a private practice needs to be reviewed carefully. Frequently, the contract is designed as a salary plus productivity-based bonus.
Keep in mind that when a practice hires a new physician, they are also taking on risks. If the salary base is high, expect the productivity bonus to be less generous, as the practice is attempting to control costs. It can be helpful to check the salary and overall compensation package against similar offers and positions. To help with salary transparency, we've compiled a salary and negotiation database with thousands of data points from our physician members. Visit the Favorite Resources section of our contracts negotiation page for the most up-to-date link to our database.
Here are some of the compensation components to consider when reviewing the contract and negotiating your final overall package:
Moving expenses are customary, but usually this is a reimbursed expense up to a limit rather than a stipend. Any amount not spent will not be money in your pocket.
A signing bonus, while also customary, needs to be approached with some thought, as It will be taxed. If the tax rate is favorable, then this could be financially beneficial. If you don't need a signing bonus to help you get started financially, it's generally better to negotiate a higher salary given that this amount will translate forward each year, rather than a one time bolus.
What is the PTO policy?
Does unused PTO carry over? Is this different for vacation and sick days?
Are there paternity/maternity leave policies? How much, if any, is paid versus taken from PTO or unpaid?
What is the bonus structure? If it's based on RVUs, what will you realistically hit?
What benefits are offered? Is there an employee match for retirement plans? How high is the deductible on the health plan?
How is the call schedule defined?
We've written a lot more about all of this as well as red flags to look out for in a contract on our contracts page, so read this page when you've gotten to that stage!
Along with our salary and negotiation database, we also have an on call information and negotiation database to help with this aspect of the negotiations. Visit the Favorite Resources section at the top of our contract negotiations page for the link to the latest version.
When negotiating your call schedule and compensation, here are some topics to discuss:
When on call, what precisely are your responsibilities and who do you cover?
Is there hospital call as well? If so, what is the relationship of the practice with the hospital?
Are you required to be privileged at specific hospitals? If so, what are requirements from that hospital for staff privileges?
Do you have to be within a certain radius for the call requirements? This will influence where you can live, which can impact your (and your family's, if applicable) happiness significantly.
Contract negotiations are also the key time to ask for anything else on your wish list. Equipment, tools, instrumentation, and specific vacation time are all negotiable.
Review the non-compete within the contract and have your contract attorney comment on the enforceability of the non-compete.
One of the most important questions to consider is what is the pathway for partnership? A good private practice will have a well-defined pathway and requirements for partnership, and it should be clearly spelled out for you.
We have an entire page dedicated to assessing a partnership offer, but here are a few key elements to consider if partnership is an avenue you wish to explore further into your career:
How well do the partners do relative to the employed physicians?
Is there a buy-in structure and definition of partnership available for applicants?
What are the advantages of partnership?
Is it likely the practice will sell to private equity or be bought out by a hospital system?
Whether you want to explore partnership potential or not, if the practice have a probability of being sold to private equity or bought out, consider if you should place safeguards in your contract in the event that this occurs.
Making a transition to a new job can be both exciting and nerve-wracking. While it's important to spend the time evaluating the private practice before you "marry into the family", keep in mind that no position is permanent. Divorce is an option when the relationship becomes complicated or downright toxic. The majority of physicians change jobs within their first two years of employment. The first job may not necessarily be your ultimate final job. Planning conservatively is prudent when entering into this new position.
We wish you the best of luck in your new endeavor! If you have a question about an offer, feel free to join the conversation in our PSG Community to get feedback and advice from over 100K other physicians. Many will have likely walked the same path at some point in their careers. We've also got a transition to practice educational series and a job board, so feel free to browse those, as well as events we've done on this topic!