Clinic or Hospital: Where Will You Be the Happiest?

When Dr. Estelle Lin was deciding where she wanted to work after residency, she wasn’t sure which path would fit her best — a clinic or a hospital setting. Rather than committing to a long-term position, she decided to try out both. For the next year, she took on shifts at both clinics and hospitals on a per diem basis.

Ultimately, Dr. Lin chose to work as an Internal Medicine physician at a Pacific Medical Centers’ clinic in Washington, where she says she has a career she’s passionate about, plus the time to do the things she enjoys and care for her family.

“I really went into it with an open mind,” Dr. Lin says. “It turned out to be the best way to explore the people, the pace and the culture of each environment. After toggling back and forth for a year, I chose to pursue clinic work. For me, the outpatient world better matched my clinical interests and allowed me a healthy work-life balance.”

Her unique approach gave Dr. Lin the real-life experience she needed to make an educated decision and opened her eyes to the benefits and challenges of each. Here, we talk with her as well as the Provider Solutions & Development Physician Recruiter, Allyson Hollingsworth, who helped Dr. Lin find her job. Read on for their insider tips on the pros and cons of each setting and how to determine what’s right for you.

"There are always options that are ‘outside the box.’ That’s why working with a recruiter who can help you navigate those options can be really beneficial.”

Working in a Hospital

Pros:

Every Day is Different

If you thrive in fast-paced environments, hospitals deliver. You’ll work with severely ill patients that require constant conversations with specialists, surgeons, nurses, case managers, social workers and families. You can expect the unexpected at any hour of the day in this acute-care environment, where you’ll be expected to think fast on your feet, make decisions quickly and move on to the next patient.

Dr. Lin says she can relate to physicians who enjoy working in hospitals. “I loved taking ownership of the patient and being their advocate,” she says. “I valued the fast-paced, serious conversations required to guide them and their families through their illnesses.”

Extended Time Off

Inpatient settings typically offer either a 7-on/7-off or 5-on/5-off schedule, plus call rotations. If you want it, overtime is often available. PS&D Recruiter Allyson says the number one thing job candidates ask her about is schedule.

“Some people love the 7-on, 7-off, because they can travel and take trips without using their PTO,” she says. “People with children will often prefer clinic-based hours, because they’re consistent, and you can be home for dinner. Personal lifestyle plays a huge part in what you prefer.”

Job Opportunities and Stability

In the hospital universe, there’s no shortage of openings, and there are many types of positions, ranging from Hospitalist to academic Hospitalist to several types of administrative leadership opportunities. Jobs tend to be stable, as hospitals are typically supported by a large health system.

Higher Base Salary

Inpatient settings tend to have higher base salaries than outpatient. Hospitals usually cover the cost of CME credits, offer PTO, plus cover the cost of malpractice insurance and other fees.

Cons:

Capped Salaries

Many hospitals are non-profits, which legally cannot pay physicians more than what is deemed in that region to be “reasonable compensation.” To retain their tax-exempt status, these hospitals set salary thresholds.

Inconsistent Schedules

Hospitals operate around the clock, so your schedule may rotate between days, nights and evenings, and you may be expected to work long hours. Weekend and holiday shifts may be required, sometimes on short notice.

Patients In Crisis

You’ll be regularly exposed to difficult situations like severe illness, stressed patients and families, and death. The hectic nature of hospitals can be demanding and draining for some. After all you have done to ensure a safe discharge, there is no guarantee the patient will be safe at home, get the treatment they need or continue outpatient care as needed.

Working in a Clinic

Pros:

Building Relationships

In an ambulatory care setting, you get to really know patients and their families, and you learn about their work and interests. You can be there for them in health and sickness. Dr. Lin says she finds working with her patient panel extremely gratifying.

“I’ve personally found it to be more rewarding to prevent a disease rather than treat an ailment down the line,” she says. “It’s a little less exciting but arguably more impactful. My favorite sign of success is when my patient improves their lifestyle choices and tell me, ‘Dr. Lin, I thought I was doing fine before, but now I have so much energy. I can breathe better. I feel so much better.’”

Predictable Schedules

Outpatient settings tend to have more standard 8 to 5 business hours, often with weekends off, and limited call. Especially in large health systems, working part time is more feasible and acceptable than it was a decade ago.

“For those who crave predictability, clinics are rooted in pre-made appointments during standard business hours, which can be a steadying force,” Allyson says.

Job Opportunities and Stability

There is no shortage of openings or demand across the country, ranging from Primary Care to Urgent Care to academic medicine to leadership positions, particularly at clinics within larger health systems.

Less Bureaucracy

In smaller clinics, there are fewer layers of management and less politics. “Physicians in clinics often feel more empowered and able to make improvements faster than those working for large hospitals, which often come with long lines and red tape,” Allyson says.

She adds that there is a middle-ground option: A clinic that exists under the umbrella of a health system.

“Working for a clinic that is part of a larger network does not mean you have to work in a large clinic,“ Allyson says. “If you want that smaller clinic feel but aren’t sold on private practice, you should know there are many small clinics that are part of a larger health system. You can have the best of both worlds.”

Cons:

Lower Compensation

Clinic salaries are often slightly lower than hospital salaries (but are rarely capped). Overtime is often limited, however, as insurance shifts to quality-based outcomes, physician bonuses for providing quality of care are substantially increasing.

Paperwork and Administrative Tasks

Patients will request that you fill out forms for them – for jury duty, sports physicals, disabled parking permits, FMLA leave, etc. You also may be required to manage supplies or complete miscellaneous administrative tasks.

More Fees, Insurance Costs, Clinic Management

In outpatient private practices, you will likely be responsible for your own professional fees and insurance. You also may be responsible for managing the staff and arranging coverage for any extended personal leave. (This does not apply if you are working in a clinic within a larger health system.)

Take Time to Reflect

These factors can be a lot to digest. Remember to be true to yourself and your needs because that is what will serve you best in the long run, Allyson says.

“Much of the decision comes down to time,” she says. “There’s the schedule that works for your lifestyle and personality, and then there’s how you are expected to use your time on the job: the pace and the style of work. Physicians who make decisions that follow what works for them are usually ahead of the curve.”

Every position is not identical either, Allyson adds. “You may be able to work part time in a hospital setting to fit your schedule better. There are always options that are ‘outside the box.’ That’s why working with a recruiter who can help you navigate those options can be really beneficial.”

Dr. Lin reminds physicians and advanced practice clinicians alike to not feel stuck where they are, especially if they aren’t feeling fulfilled or happy.

“I would advise that situations change and to never close any doors,” Dr. Lin says. “What works for you now might be different in a few years. Don’t feel like you have made an end decision when you sign on to your first job. There’s always a chance to do something different, join a committee or become a leader in your group.

“Explore and imagine new opportunities for yourself. Make sure you take care of yourself, and choose a career that matches your own needs first, so you can better take care of your family and your patients.”

Want to discuss your options with an expert Recruitment Advisor? We have those on deck at Provider Solutions & Development. We offer holistic, personalized career guidance to help you find the right fit, at every step in your career. Start the conversation today.