How to Avoid Joining the Wrong Physician Practice

Written by: Dr. Nisha Cooch
Published on: Jan 23, 2020

Stressed Doctor

Despite all the time physicians spend training, their training generally does not provide guidance on how to choose a position once they’re fully credentialed in their fields. Many budding physicians simply focus on whether to pursue academic medicine or private practice. Navigating options in the former case can be relatively straight forward. However, comparing different private practice options is often daunting.

As with any job search, physicians seeking private practice roles need to think about what they want in terms of location, compensation, schedule, vacation time, and benefits. Also relevant for this group of professionals, though, are details of malpractice, how much nursing and administrative staff they will have, what their call schedule looks like, which EMR system they will use, the size of the practice, the number of partners, and the practice model. While determining the ideal scenario related to each of these issues and prioritizing preferences, physicians should also be aware of some other keyways to evaluate private practices. Here are three things that can help you choose the right practice.

Know the buy-in cost. It is not uncommon during the recruitment process for partners in physician practices to entice new doctors with the potential of partnership after a couple of years with the practice. The problem is that becoming a partner often requires that you pay to do so. Complicating matters is that the buy-in amount can range significantly and, in some cases, is astronomical. Becoming educated on how the buy-in works and what it would cost you can help you avoid the disappointment of learning that the price of buy-in precludes you from doing so.

Doctors talking

Learn the business model. There are several ways that physician practices can be set up, and it is important for you to understand who gets paid what and why if you are going to be happy and thrive in private practice. Pyramid structures, for instance, in which senior physicians skim off the top by charging overhead to junior doctors, can be financially debilitating for new physicians, particularly given that physicians are also required to pay large malpractice fees. While you probably want to avoid blatant pyramid structures, there may be some more subtle red flags in a practice’s business model. If only a small proportion of the partners are high producers, for instance, you should ask why. You should also learn as much as you can about how referrals and patient scheduling works and how profit is shared.

Don’t underestimate the importance of the culture. Working with senior doctors who invest in you is invaluable. Unfortunately, garnering significant support from senior doctors is not something that happens in every practice. A practice that does not prioritize teamwork and the success of their junior doctors is likely not the best place for you to develop your skills or to be compensated fairly. While culture can be challenging to evaluate before joining a practice, investigating the trajectory of other junior doctors at the practice can give you an idea of the support they have received. High turnover may also be a red flag.


Medical training may provide you with the skills to be an excellent clinician, but it does not necessarily prepare you to choose the best job in your field. Understanding the important questions to ask and figuring out how to collect as much information about the realities of a practice as possible can significantly improve your chances of ending up in a practice that is a good fit for you.