Should you work in a hospital or private practice?

Both come with a specific set of headaches and career development. Let’s examine.

Should you work in a hospital or private practice?

Deciding where you want to work as a health care provider is a pretty big choice. A multi-state hospital system, for example, has a very different vibe than a neighborhood clinic owned by a family doctor. Each organization comes with its own brand of rewards and headaches.

They each come with their own unique paths for career development, too.

“There will always be opportunities at hospitals, but not only are the opportunities outside the hospital growing, but so is the scope of work,” says Donna Cardillo, a nursing career coach and author based in Sea Girt, New Jersey.

So, which environment is right for you? Let’s help you figure it out. Here’s a breakdown of the three biggest differences between working in a hospital and a private practice.

How you get paid

The difference between working in a hospital and a private practice will show up in your first paycheck. Hospitals often have higher base pay, but they also tend to have set pay schedules for roles, and even include salary caps. Private practices tend to pay less, but have more room for negotiation, depending on the size and scope of the practice, Cardillo says.

Other ways the two can differ include:

Metrics. Would your compensation be tied in any way to patient or satisfaction metrics? Hospitals may be more likely to use metrics in setting compensation.

Overtime and differentials. Would you have opportunities to work extra hours? In hospitals, RNs and LPNs have plenty of chances to pick up shifts and earn shift differentials, Cardillo says, but that may be rarer at a private practice that is open only during regular business hours.

Employee benefits. What kind of health insurance is available? Many hospitals are self-insured and because the have more employees, they're often able to keep employee costs down, says Carmen Kosicek, a nurse and CEO at Alay Health Team in Pewaukee, Wisconsin. However, you might be limited to care within the hospital and affiliated providers, she says.

Perks. What other extras are available? Hospitals have larger HR budgets and may be able to pay for things like relocation, tuition reimbursement and other perks.

How you spend your time

Differences between working at a hospital and a private practice are evident as soon as you walk in. In a hospital, higher volume expectations and a larger support staff mean providers will usually see more patients with a larger variety of issues. The role of nurses in particular has expanded at hospitals, Cardillo says. “Besides direct bedside care, they may also be care managers or case managers,” she says.

Private practices may provide more of a routine, Cardillo says, but they may also provide the opportunity to add higher value to a care role. People who work in private practice often have the chance to contribute to broader patient education, for example.

Other ways the two differ include:

Support. What kind of administrative staff does the facility have, and what is their scope of work? Hospitals are likely to have more administrative support than private practices, so you could find yourself doing more data entry or paperwork at a private practice.

Patient population. What kind of cases does the facility tend to see? While things can get hectic at private practices, they tend to see more preventive cases or ongoing issues, while hospitals tend to have more patients in life-threatening situations, Cardillo says.

Flexibility. What kind of work-life balance is available? Hospitals can offer more options on shifts, but less flexibility during those shifts; a private practice often has regular business hours, but flexibility within them. “In a private practice, you can ask if you can come back 30 minutes later from lunch; you certainly can’t do that in a hospital,” Cardillo says.

Time with patients. How much time, on average, do providers spend with patients? Teri Dreher, owner and CEO of North Shore Patient Advocates in Chicago, says she’s able to spend most of her time with patients and isn’t rushed in her care delivery.

How everyone works together

The size of hospitals and private practices shapes how you’ll interact with your colleagues every day. Large hospital systems may feel similar to an established corporation, while working at a smaller private practice may sometimes feel like a startup—everyone pitches in where they’re needed.

Hospitals create an employee-employer relationship, says Ramin Javahery, chief of adult and pediatric neurosurgery and spine surgeon at Long Beach Memorial and Miller Children’s & Women’s Hospital in Long Beach, California; he is also a part of the Coast Neurosurgical Associates private practice group. In private practice, your livelihood depends on referrals, Javahery says, which can boost the entrepreneurial spirit.

“Working in private practice gives doctors that ownership in the quality of care they provide,” he says.

Other factors that tend to differ between the two:

Model of care. How is patient care managed? Is it team-based, holistic, top-down? In a private practice, the provider is often the ultimate decision-maker, versus a business-minded person in a hospital, Kosicek says.

Career path. What kind of long-term opportunities are available at the facility? A private practice may be able to offer more flexibility and opportunity for self-driven research or advocacy, Cardillo says, while a hospital may have a more structured path. But a hospital also may be able to offer much greater opportunity for advancement and have more resources for employee development.

HR processes. How is performance monitored and assessed? What is the process for addressing patient complaints or performance evaluations? Hospitals are more likely to have an established HR process, as well as collectively bargained discipline procedures. Private practices may be more flexible, but may not have processes in place.