Physicians seeking their first job after residency or fellowship training have options. Do they want to enter private practice? Pursue a nonclinical career? Increasingly, they are considering and pursuing an employment model of practice, which can be attractive for a number of reasons.
“I had the impression during residency that being an employed physician would mean having a lot of structure to your day—for example, having a report time and a dismissal time—but that's definitely not been the case for me,” said AMA member Alisha Reiss, MD, a general surgeon in Greenville, Ohio, and the immediate past chair of the AMA Young Physicians Section Governing Council.
“I have a lot of autonomy over my schedule,” she added. “Yes, your employer will often set your office hours and maybe which days you're permitted to do procedures. But I'm not committed to sitting in my office until 5 o’clock. Whenever my work is done, I can leave.”
Though being an employed physician can have drawbacks, for those like Dr. Reiss, it can be a path to a career that allows you to balance your work with your life outside of your career. To help physicians considering the employment model, she offered the key points she thinks every resident and fellow should know about practicing as a physician employed by hospital, health system, or other healthcare entity.
Physician job seekers should also explore the JAMA Career Center®, which presents physician career opportunities, news and information relevant to the full spectrum of medical practice. Search for physician jobs by specialty and location or browse all of the physician jobs by specialty.
The move to physician employment
Selecting employment over private practice is a decision that makes sense for an increasing number of physicians. AMA research shows that fewer than half—42.2% of physicians—were working in private practice as of 2024. That represented a precipitous drop from 2012, when 60.1% delivered care in that setting.
Private practice remains an attractive setting for hundreds of thousands of American physicians, offering a higher degree of flexibility and autonomy to deliver a high-quality, individualized type of care. The inaugural AMA Independent Practice Accelerator Workshop, held in October, was a two-day, in-person event designed to give physicians the essential knowledge, practical skills and confidence to launch or strengthen an independent practice in a concentrated, high-impact format. Dates for 2027 will be announced when available.
The workshop is part of the new AMA Career Advancement Collective, a powerful suite of educational programs and training to help physicians develop and advance at every stage of their career.
At the same time, there are elements of working as an employed physician that are appealing to many doctors. Being your own boss, or sharing the role with co-owners of a private practice or medical group, means the buck stops with you when it comes to tackling complex, regulatory, administrative and payment challenges such as the decadeslong drop in Medicare physician payment (PDF).
Those are burdens that Dr. Reiss, for one, is glad to share with her employer, a health system in Western Ohio.
“I don't have to worry about many of the nuances of day-to-day business management,” she said, adding that her medical training didn’t include how to run a business. “In fact, that was more intimidating to me than doing major surgical operations.”
Get an introduction to the business of medicine with this AMA Ed Hub™-curated selection of educational resources, which includes a variety of introductory topics to help practicing physicians take a more proactive role in shaping their own futures in medicine. And find out more what private practice is and whether it is right for you.
A realistic picture of business tasks
Dr. Reiss said that while there are some benefits to leaving the administrative tasks to others, there are certainly downsides.
“I don't sit in on many meetings about costs, and I don’t worry about hiring and firing staff, which is a pro and a con,” she added. “If you have staff you don't love, you also don't have the ability to replace them if you’re not their direct employer.”
And as an employee, a physician may have both more limited earning potential and also more limited risk when it comes to financial losses.
“You're going to have more of a set income,” Dr. Reiss said. “Through the COVID-19 pandemic, for example, I was probably more protected than many of my private practice colleagues.”
Dr. Reiss’ contract includes a base salary and a bonus for productivity, then separate compensation for call.
“A private practice’s model of compensation is definitely different from the employed model,” Dr. Reiss said. “They get paid based on what they collect, so time management is very important to maximizing your profit. In an employed model, I get paid for working.”
Learn more on evaluating practice environments to match your priorities with the AMA STEPS Forward® toolkit, “What to Look for in Your First or Next Practice.” It is enduring material and designated by the AMA for a maximum of 0.5 AMA PRA Category 1 Credit™. Read up on AMA CME accreditation.
Look beyond the big number
For resident physicians in the transition to practice, the base salary may initially seem exciting. But Dr. Reiss said it’s important to investigate and determine what contracts in your specialty are typically like.
“There's a wow factor when you first see a compensation number because you’re leaping from a resident salary to an attending salary,” Dr. Reiss said. “So even if you see a number that's not your fair-market value, you may still be in awe of that number because it's significantly different from your resident compensation.”
Additionally, what does the contract say about signing bonuses? Noncompete clauses? Call requirements? Tail insurance coverage? Many employment terms beyond salary can make a tremendous difference in your finances and job satisfaction.
“Too many people often get caught up strictly on that base-pay piece,” she said.
Coming to a fair agreement
The next step for all physicians considering accepting an employed position should be careful negotiation. Dr. Reiss said residents and fellows may feel uncomfortable pressing for more. That’s where a strong advocate comes in handy.
"As a new grad, I felt guilty—like I was asking for too much and I should just settle for whatever they offered. Fortunately, I had a strong lawyer who encouraged me to work for what I wanted,” she said. “He told me the worst they can say is no, and then we’ll come back with something. But if they say yes, then you've gotten another piece you wanted.
“If you ask for something that's really important to you and they deny it, that's probably a red flag that it's not a good fit for you and you don't need to settle for that contract,” she added. “You need to look beyond and find something that fits your goals and aspirations.”
With the importance of weighing all the factions in an employment contract, it’s crucial to ensure that you get expert help.
AMA members receive a 20% discount on all Resolve services. With Resolve, you get:
- Custom contract review for any type of employment contract.
- Access to experienced attorneys who can negotiate on your behalf.
- Real-time, comprehensive compensation data and benchmarks to help you understand your worth.
- An instant contract-review option, powered by Resolve’s attorney-trained AI model.
- Free tools such as a contract scorecard to give a quick overview of where your contract stands.
Ready to access your AMA-member Resolve discount? Learn more now.
And if you’re seeking your first physician job after residency, get your cheat sheet now from the AMA.
—Contributing News Writer Timothy M. Smith contributed to this story.
