OBGYN Career Paths: The 4 Practice Models Every Resident Needs to Know Before Job Searching (Part 1)
When I was a med student, I almost didn't pursue OBGYN — not because I didn't love the specialty, but because I thought I only had one option: the high-volume, always-on-call private practice model. It wasn't until I started applying for jobs as a PGY-4 (and then later as an attending) that I realized how many different ways you can actually practice in this field. Like many residents transitioning from training to attendinghood, I felt completely in the dark.
This post — pulled from Episode 21 of the OBGYN Resident Survival Guide — is my attempt to give you the starting point I wish I'd had. We're covering the four main employment structures for OBGYNs in the United States, with the real pros and cons for each.
Note: Next week's episode (Part 2) will cover how you can practice within these structures — as a generalist, hospitalist, or contractor.
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The 4 Employment Structures for OBGYNs
No matter where you end up, your employment will fall under one of these four models:
Private Practice
Academic Practice
Hospital-Owned Practice
County / City-Owned Practice
Let's break each one down.
1. Private Practice
Private practices are physician-owned businesses. Revenue comes from office visits, procedures, surgeries, and deliveries. There's typically a practice owner who runs the business and associates (the other OBGYNs) who are salaried employees. For most of you reading this, you'd be entering as an associate — not starting your own practice right out of residency.
Potential Pros
High volume and breadth of experience — especially in smaller group practices where you're sharing the load with fewer people.
More surgical exposure, since attendings often assist each other in the OR rather than relying on residents.
Higher earning potential — salary plus profit distributions, with fewer caps on productivity bonuses.
Your patients are your patients — strong continuity of care and the ability to build your own practice identity.
Potential Cons
Grueling call schedules — in a 4-person practice, you could be on call every 4 days or one week per month.
No set shift hours — you may go from clinic to the OR to labor and delivery, all in one day.
Tail malpractice insurance is often on you when you leave — potentially tens to hundreds of thousands of dollars out of pocket.
Best fit if: You want high volume, love complete continuity of care, and prefer that clinical decisions are made by physicians — not administrators.
2. Academic Practice
In academic practice, you're employed by a university teaching hospital. Your time is split between clinical care, teaching residents and students, and often research. You're an employee — no business management required.
Potential Pros
Resident support — they do a lot of the legwork (notes, consents, prepping patients), which frees you up to supervise rather than do everything from scratch.
Resource-rich environment with access to specialists and sub-specialists for complex consults.
Opportunities for mentorship, leadership, and research with institutional support and funding.
Hospital typically covers your tail insurance if you leave.
Potential Cons
Teaching takes time — clinic runs long, surgeries move slower, and you have to be patient with trainees.
Less continuity of care — you may see someone for a new OB visit and never see them again, or scrub a surgery on a patient you've never met.
Additional responsibilities like lectures, research oversight, and evaluations on top of clinical duties.
Base pay is often lower than other models, though career development opportunities are part of the package.
Best fit if: You love teaching, want to be involved in research, and value having a strong support system — especially early in your career.
3. Hospital-Owned Practice
In this model, you're employed by a health system — think Kaiser Permanente, Providence, or Advent Health. The hospital owns the practice, handles overhead and staffing, and pays you as an employee. This is probably the most corporate of the four models, and that cuts both ways.
Potential Pros
Highest base salaries and sign-on bonuses — friends have received anywhere from $15,000 to $200,000 (with associated commitment requirements, of course).
Great option for paying off student loans or buying a house fast.
Can still have your own patients with strong continuity of care, depending on the group's model.
Attending-to-attending OR mentorship is often built in, since there are no residents assisting surgeries.
Tail insurance typically covered by the hospital.
Potential Cons
Physicians have very little control over scheduling, department operations, or clinical workflows.
Schedules can be overloaded (30+ patients per day) because the primary goal is revenue — and the people building your schedule aren't clinicians.
Departmental changes move slowly through multiple layers of administration.
Best fit if: Financial goals are your top priority coming out of residency and you're okay trading some autonomy for a high, stable salary.
4. County / City-Owned Practice
County and city-owned hospitals are run and funded by local government. Examples include any county hospital system or the NYC Health + Hospitals system (H+H). These institutions primarily serve underserved, high-acuity populations with complex social needs — and that shapes everything about the job.
Potential Pros
Meaningful, mission-driven work — you have a real opportunity to provide safety-net care for patients who might not have access anywhere else.
You'll see more varied pathology and complex clinical situations, which can accelerate your growth as a clinician and surgeon.
No business management responsibilities — you focus purely on clinical work.
Often have resident support through affiliated or in-house programs.
More opportunities for early career leadership, simply because there's more need and less competition for those roles.
Potential Cons
Lower-resource settings — specialists may not be available in-house, and you may not have access to the latest devices or facilities.
Like hospital-owned practice, physicians often have limited control over department operations.
Clinic can get massively overbooked — the system is designed around access, not efficiency. When demand exceeds capacity and all patients show up, you may be seeing 30-40 people in a day.
Caring for complex, high-risk patients without adequate resources can be stressful and nerve-wracking.
Best fit if: You're passionate about health equity, teaching, and advocating for vulnerable populations — and you can handle working in a resource-limited environment.
Final Thoughts
None of these models is objectively better than another — the right one depends entirely on what you value. What I hope you take away is that you have real options, and the more you know about them going into the job search, the more likely you are to land somewhere that actually fits your life and your goals.
My biggest advice: find people in your residency program or network who are working in the models that interest you and ask them everything. First-hand experience will always tell you more than any podcast or blog post.
Tune in next week for Part 2, where I'll break down the different roles within these structures — generalist, hospitalist, and contractor (locums/per diem).
Listen to the full episode on the OBGYN Resident Survival Guide podcast.
