(Mods, if you think this belongs in the career thread(s) I'm happy to put it there, however I think this has larger overarching themes that may benefit from broader exposure.)
In my mind, and someone experienced please correct me if I'm wrong, private practice means freedom. I don't mean it in a naive sort of way, as I realize private practitioners end up working much more patient-per-patient than their hospital-employed counterparts. But I do see it as them working on their own terms.
The above is not the immediate case when you come onto a practice as a hiree. I realize that. But there's a reward in it for you if you stay with that practice long enough. I feel like the seniority comes with a certain degree of doing things your own way, in a way that seniority in the academic or hospital-employed clinical setting doesn't (not talking about physician-scientists in this post).
As recently at the 90s and early 2000s, starting your own private practice was definitely a thing you could do right out of training. You had to be somewhat entrepreneurial of course, but it wasn't something that you had to get an MBA to pursue.
Hospital then starting buying private practices. I don't know how it ends up being more lucrative for the hospitals, but as they employed more physicians the need for those physicians didn't suddenly appear, because it was still taken care of. I.e. just because the hospital swallowed private practice X in that region, doesn't mean the region is lacking that- the hospital covers their own need for whatever docs used to be private.
But there are still needs. And I'm not talking about backwoods Montana or other uber-rural areas. I mean places not even that far away from bigger urban sites. New England, Florida, California, urban/suburban Texas.
So what's stopping us from starting a group of our own, getting privileges at hospitals, and just working?
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