One of the most critical decisions you made in medical school was your preferred residency specialty. Now that you’re a resident, the big decision is selecting the type of practice you would prefer to work. After that, your post-residency checklist, including shaping your CV, searching for jobs and working with recruiters through PracticeLink, is a breeze.

Careers require thoughtful preparation and evolve over time. Will yours get off to a bumpy start or will it begin with early success? The factors you consider now could make all the difference. Start by compiling a pragmatic list of considerations: work hours, educational debt, experience gained, experience needed, pay and benefits, recognition, quality of life, pressure and time dealing with medical records.

Then, develop a more theoretical list (how do you prefer to work as a physician, what are your goals, how do you envision your professional journey) as well as an introspective list of what you’re like as a person, such as your temperament, sense of humor, level of patience, ability to avoid conflict and other indicators of how well you do or do not play with others, follow the rules, make friends and thrive in fast-paced environments.

Resolute in who you are, what you want and how you want to live. Deciding what type of practice is best to begin your career is all that’s left. Here’s a breakdown of the different practice types, with some insight on how they might fit in with your goals and help you know how to choose the right physician practice.

Solo practice

If you enjoy full independence to make the rules and set your own schedule, and you have the financial backing, then setting up a solo practice might be right for you. Your costs could reach $8,900 per month, plus a $10,000 – $15,000 initial investment for equipment and other necessities. Then of course, there’s thousands in annual insurance and malpractice insurance fees. Financial compensation is based on profits, which in turn can be impacted by payroll and how quickly you can establish a patient base.

During the pandemic, many specialty practitioners couldn’t find work and had no choice but to set up solo practice. For these practitioners, doing everything alone was scary but not working at all was scarier.

Solo practices are yours to design, grow and develop according to your vision and ability. If you value nurturing ongoing relationships, they allow you to develop close, personal connections with your patients and staff while providing your own unique style of medical care.

Solo practices come with a lot of trial-by-fire learning curves. The burden of running them, including working with insurance companies, federal compliance, patient growth and retention, payroll, etc., rests entirely on you. Additionally, where you set your practice can determine its success.

Group practice

If you dream of setting up a practice with friends in your specialty or establishing a multispecialty practice, or if you simply prefer strength in numbers, then setting up or buying into a group practice might be right. With this, clinical and financial risks are shared, even though the overall cost isn’t necessarily cheaper than a solo practice. After all, the space will be bigger, and you’ll need to furnish each physician’s private office as well as more patient rooms. Even if you join an existing group practice, you’ll likely be asked to contribute a hefty amount as a buy-in.

Downsides to a group practice include less autonomy than a solo practice and the unfortunate potential for conflict, making them a poor choice for bullies at one end of the spectrum and the faint of heart at the other end. However, level-headed extroverts who can speak up for themselves rather than shy away from tough clinical and managerial decisions would do well.

Private equity

Private equity firms are increasingly targeting solo and group practices that are privately owned and are struggling, retiring or facing regulatory challenges. The difference between investments from private equity firms and investors you bring in yourself is that private equity firms essentially buy and restructure your practice to create more value and higher profits.

According to the New York Times, private equity firms “have been gobbling up physician practices to form powerful medical groups across the country.” Quoting a study from the American Antitrust Institute, private equity firms own more than half of all specialists in many U.S. markets, including Tucson, Ariz.; Columbus, Ohio; and Providence, R.I.

If you want to stick with a private practice setting but don’t have the money, resources or technology to keep it going, this could be perfect because it comes with a quick infusion of cash and often helps spur innovations.

The downside is that private equity practices can be unbearably money driven. Expectations for a quick return on investments—sometimes for as much as 20 percent—can clash with your patient-centric ideals.

Independent contractor

If you want a group environment but you’re not comfortable with conflict, an attractive hybrid between a solo or group practice is to share the facility and/or costs of an existing practice but remain independent. The cost is far less than a full buy-in, and you enjoy nearly as much autonomy as a solo practice.

The disadvantage, however, is the loss of authority and decision making with regards to how the overall practice is run. Also, you may not be taken as seriously among your peers and the staff, and the other doctors might not be willing to share techniques and best practices. Being isolated like this might be unnerving for someone who likes to fit in.

Employed physician practice

If you thrive in the dynamic pace of a hospital, where you’re helping patients often in their most dire conditions, and you like the idea of being enmeshed in a learning environment with teams of people in your specialty and others, hospitals might be right for you. Many solo practitioners have recently found hospital employment ideal because of the growing demand for telemedicine and all the regulations and software that comes with it, as well as the hassle of dealing with low reimbursement rates from Medicare and insurance companies.

Getting paid directly from a hospital or other healthcare organization can happen in a few different ways: The healthcare organization can purchase or manage your solo or group practice; you can be an employee at a practice that’s come under a healthcare organization’s wing or you can apply directly to the organization.

The simplicity of working directly with a hospital allots for more time to focus on practicing medicine. Because the organizations employing physicians tend to be larger, they usually have more resources than solo or independent group practices. Clinically, this usually means reasonable coverage for clinical responsibilities and improved control of lifestyle. This larger size and increased resources may also translate into more robust support services and opportunities for further education and training.

Whether good or bad, compensation such as salaries, raises and bonuses are contractual. If you feel like you’re worth more than what organizations in your area are offering, or you feel like pay scales aren’t equal, then traditional employment can be frustrating.

The downsides are very little autonomy, burdensome performance metrics, salaries are often capped, your schedule could rotate between days, evenings, and overnights and you might be required to work weekends and holidays. For instance, scheduling and productivity expectations: There may be less clinical flexibility due to limitations of referrals and facilities based on the employing organization. Additionally, there may be other expectations, such as joining committees or other organizational activities.

Medical subscription practice

Concierge practices, also known as retainer medicine and Direct Primary Care practices, are a modern phenomenon where patients are charged a flat membership fee on a monthly, quarterly, or annual basis instead of submitting insurance claims for certain services. For example, EuDoc, a subscription service in Midlothian, VA, charges a $99 initiation fee and $99 per month for adults 27-64. The Concierge Cardiology Program at St Louis Heart and Vascular costs $1,600 per year, but also boasts appointments can be same day or the next day.

Patient subscribers have lauded subscription services for delivering the friendliest, most comprehensive health care they’ve ever gotten. Doctors can spend more time with patients—reportedly 45 minutes or longer—because they’re not constrained by time limits from insurance companies. They also don’t see as many patients.

At a typical practice, physicians might see 2,500 patients, and most concierge services average 300 patients per doctor. By comparison, The Sheldon Sowell Center for Health charges $18,000 but only has 120 patients per doctor.

While insurance claims can be used for labs, imaging, medications, and specialists, subscription services eliminate insurance co-pays and third-party billing, which simplifies the administrative burden for both patients and physicians and makes the costs of care more transparent.

Veterans Health Administration

The VA system of medical centers and outpatient clinics is the largest integrated healthcare system in the United States and is indispensable to veterans. There are several advantages to working with the VA. Doctors can participate in research, training and clinical innovation projects. They can also collaborate with universities, federal agencies, nonprofits and private industry. If you love the academic and research sides of medicine and would like to pursue a significant impact on the health of veterans and the nation, being a physician with the VA might be your perfect fit.

Additional benefits are that your physician’s licensure is valid in all 50 states, you’re are not required to sign a noncompete clause, the average base salary for physicians is $250,000, and you can receive annual performance bonuses of up to $15,000.

The downsides include high bureaucracy and low salary, particularly compared to working in a private hospital or what you could earn in a solo practice. Also, there’s no sugar coating the fact that a lot of veterans have debilitating physical and mental health challenges, as well as extreme anger with a system they complain requires months to get an appointment and lets too many sick patients slip through the cracks. As rewarding as the VA can be, by all accounts, it takes a thick-skinned personality to be able to thrive.

Humanitarian aid

Doctors Without Borders / Médecins Sans Frontières is one of the most reputable humanitarian organizations. Along with the lesser-known Doctors of the World / Médecins du monde, they provide emergency and long-term medical care to the world’s most vulnerable people. There have been countless reports from immigrants and refugees who have said Doctors Without Borders provided the first safe space where they felt comfortable enough to open up about their medical needs or traumatic experiences and that humanitarian aid doctors were the first to genuinely listen to what they had to say.

If you want to travel, practice medicine abroad, develop deep connections with other cultures, and have an immediate impact in places where without you, there might literally be no one else, then working as a humanitarian aid doctor might be right. It pays around $98,000 a year, and all expenses for necessary vaccinations, visas, work permits, transportation and possible evacuations are completely covered. You also receive a daily per diem during assignments.

The downsides are that it can be difficult to pursue a personal life or build a family, and you often must endure extremely stressful working and living conditions, possibly far beyond what you might be accustomed to. Additionally, there are frequent security and safety concerns the organizations have no control over.

Locum tenens

If you’re interested in making a lot of money fast and want to explore different hospitals and cities before settling down, then locum tenens is a great option. Most institutions require board certification, which is difficult right out of residency. Nonetheless, working as locum tenens has a number of benefits, including better financial compensation, reduced administrative tasks, professional development, exposure to different medical settings and greater flexibility in terms of location, practice, patient load and schedule.

Financial compensation is, by far, one of the biggest draws of locum tenens. One anesthesiologist boasted in a forum about retiring at the age of 41 from just doing locums after residency. A cardiac surgeon shared his recent emails for locum work, which included an opportunity for two weekends a month for $5,000 per weekend, with an additional $275 per hour if he worked for more than 4 hours. Another request was for five days around Thanksgiving, at $2000 per day, and an additional $300 per hour over 4 hours.

The downside of locum tenens is credentialing and licensing. Getting privileges for each hospital can require a lot of paperwork, particularly if assignments are outside the physician’s state of residence.
There also tends to be a lack of social and emotional support, as well as the headache of navigating new systems.

In the end, when considering which type of practice you want to join, understanding all the challenges is just as important as reveling in everything that’s potentially great. Beyond that, no decision can be made without factoring in who you are as a person – and how you work as a physician. When mulling over your options, don’t forget to keep in mind what you truly love about being a doctor and the kind of lifestyle you want outside your practice. In the end, trust yourself, think about what makes you happy and don’t be afraid to change your mind. If you can do that, you will definitely come up with the right answer.