Do private practices offer more surgical autonomy than larger hospital settings?
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Autonomy is nuanced
At first glance, the answer to this question would seem to be obvious.
A surgeon in a private practice who makes all the decisions regarding staffing, clinic, location and types of patients that are cared for would have more autonomy than the surgeon who works for a large hospital. However, the actual answer is more nuanced.
The surgeon who works for a large health care facility, while familiar with the finances of their department or division, in most cases, is not solely responsible for their own overhead. In large systems, the economy of scale is used to spread the cost of doing business across the institution, and the surgeon then has more autonomy to focus on their individual practices. Also, the time and resources necessary to obtain and maintain highly regulated health information, manage human resources and billing, and obtain malpractice insurance are other reasons physicians may be driven away from private practice.
Being part of a larger system provides protection for innovation. If the surgeon is not managing an office, he or she can focus on the creative portion of surgical care. Large leaps in techniques and technology can be found in larger hospital settings. In addition, larger facilities will have many employed lawyers to assist in patent creation and protection.
In full disclosure, I work at the Mayo Clinic where I have been employed for 10 years. The mantra of “putting the patient first” is echoed across this campus. I am willing to let go of some small parts of my autonomy so that I can focus on the families who come to me for help. In addition, I can offer them innovative surgical techniques and know that my large hospital setting will support me.
Todd A. Milbrandt, MD, MS, is chair of the division of pediatric orthopedics at the Mayo Clinic in Rochester, Minnesota.
Private practice is ideal
For pediatric orthopedic surgeons, career paths diverge at a crucial juncture: academic practice, hospital employment or private practice. While each offers unique benefits, private practice presents distinct advantages that empower surgeons to deliver exceptional patient care, achieve financial security and foster a fulfilling professional experience.
One of the most compelling features of private practice lies in its autonomy. Surgeons have greater control over patient care protocols, treatment plans and practice management decisions. This allows them to tailor their practice to their specific expertise and philosophy, fostering a personalized approach that best serves their young patients. Unlike academic settings where research obligations may compete with clinical time, private practice allows surgeons to prioritize direct patient interaction, building strong relationships with families during critical growth and development stages.
Private practice also offers greater financial security and potential for increased income. Surgeons directly benefit from the success of their practice, incentivizing them to optimize patient care and practice efficiency. This financial security allows surgeons to invest in cutting-edge technology and resources, further enhancing the quality of care provided.
Furthermore, private practice fosters a collaborative and entrepreneurial spirit. Surgeons have the freedom to build a team of health care professionals who share their vision for patient care and practice management. This collaborative environment fosters innovation and allows surgeons to directly impact their patients’ lives in a meaningful way, creating a sense of ownership and fulfillment.
While concerns exist about administrative burdens and business acumen in private practice, these challenges can be mitigated through strong business partnerships with experienced practice managers. In addition, professional organizations offer resources and guidance to help surgeons navigate the complexities of running a successful practice.
In conclusion, for pediatric orthopedic surgeons seeking to prioritize direct patient care, achieve financial security and foster a fulfilling professional experience, private practice offers a compelling path. It allows surgeons to leverage their expertise and build a practice aligned with their values, ultimately leading to a more impactful and rewarding career.
- References:
- Colwell J. Med Econ. 2016;93:42, 44-46.
- Fedok FG, et al. Facial Plast Surg Clin North Am. 2020; doi:10.1016/j.fsc.2020.07.001.
- Mahoney ST, et al. JAMA Surg. 2021; doi: 10.1001/jamasurg.2020.5670.
- Oladini L, et al. J Am Coll Radiol. 2023; doi:10.1016/j.jacr.2022.10.002.
- Pofeldt E. Med Econ. 2015;92:48-49, 54.
- Private practice vs. employed practice. https://www.aaos.org/videos/video-detail-page/25614__Videos. Published Nov. 4, 2022. Accessed May 7, 2024.
- Rajabi-Estarabadi A, et al. Clin Dermatol. 2020; doi:10.1016/j.clindermatol.2020.05.012.
Mark A. Rieger, MD, CFP(R), is a managing partner of The Pediatric Orthopedic Center, former chair of Consensus Health Medical Group and founding member of of OrthoNJ in Cedar Knolls, New Jersey.
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