Identifying the right practice setting can be an arduous task. In a recent YoungMD Connect workshop, Geeta Lalwani, MD; Margaret Chang, MD; Alan Ruby, MD; and Jay Sridhar, MD, discussed a range of setups—including group practice, solo practice, and academia—and shed light on how private equity (PE) factors into the equation.
The Pros and Cons of Working in a Private Practice
Geeta Lalwani, MD | Boulder, CO
“Lifestyle is important to one’s happiness.”
Dr. Lalwani emphasized the importance of factoring lifestyle and location into your practice considerations. For example, do you need to be near family, or close to the mountains or beach? Talking to longtime practitioners can help you to understand what type of practice will suit you. With any practice you target, research the culture as thoroughly as possible, she advised.
Dr. Lalwani also provided some sample questions to ask when interviewing for a private practice position, including:
- What does it take to become a partner?
- How would I build equity within the practice?
- What is the practice’s parental leave policy?
What You Need to Know About PE
Margaret Chang, MD | Sacramento, CA
“Not all PE is the same. How these practices are structured and run differs.”
As Dr. Chang noted, the structure of PE practices differs based on their vertical versus horizontal integration. Vertically integrated PE practices are often in the same local area and refer to each other. They usually combine optometry, general ophthalmology, and retina. An example of a horizontally integrated group is a large organization of retina-only practices in different geographic areas. They share decisions on equipment, drug purchases, and clinical research.
Dr. Chang commented that in PE, the structure of the partnership is often different than it is in private practice. Although the ending partnership salary may not be as high as in traditional private practice, the associate salary is often much higher, and the track to partnership is usually much shorter. There is no buy-in at the end of the associate track, and there is usually some profits interest or equity based on the growth of the parent company that may be offered at the end of the associate track. Dr. Chang added that, in a PE setting, the amount of physician versus corporate control may vary.
Candid Talk About PE Medical Practices
Alan Ruby, MD | Royal Oak, MI
“If you like the people running a practice, you’ll set yourself up for success.”
Shedding more light on PE, Dr. Ruby described how PE medical practices are just private practices that have partnered with a PE enterprise. PE firms choose practices that are well-run, and they do not want to interfere with that success. PE is run like a business, wherein certain financial risks may be magnified or minimized.
Rather than limiting your options to exclusively PE or private practice, Dr. Ruby suggested evaluating the practice itself. Leverage your negotiation power, he advised, as private practices, PE practices, and academic institutions all compete for high-quality people. Focus on a subspecialty that sets you apart from other candidates. As for research, Dr. Ruby noted that, regardless of affiliation, most enterprises do not limit research opportunities.
What You Need to Know About Working in Academia
Jay Sridhar, MD | Miami, FL
“Take all advice with a grain of salt, because everyone’s employment needs are different.”
On the academic side, Dr. Sridhar discussed some of the strengths and drawbacks of this practice setting. In academia, there is less volatility related to market forces, such as contractions (like during the COVID-19 pandemic). It is also easy to practice multidisciplinary care, as hospitals provide the time, resources, and access to specialists. It is more challenging to coordinate collaborative care in private practice.
As for the drawbacks, Dr. Sridhar described some of the operational inefficiencies associated with academic practice. For example, the workflow will not be as fast as in private practice, and physicians may not get the accountability or resources they need. He also noted that there is great access to research in an academic setting, but also more bureaucracy (plus, pharmaceutical trials are more difficult to conduct in academia). Further, academic institutions make money through grant funding or by clinicians generating revenue, so practitioners may need to justify their salaries.
CONCLUSION: There is no one-size-fits-all practice setting. Understanding the differences between the various options will help young ophthalmologists to identify the path that appeals most to them professionally and personally, and to set out—and occasionally pivot—with confidence.
