Podcast Summary: The OB/GYN Resident Survival Guide
Episode #21: OB/GYN Career Paths: The 4 Practice Models Every Resident Needs to Know Before Job Searching (Part 1)
Host: Dr. KC Miller
Date: March 2, 2026

Episode Overview

In this episode, Dr. KC Miller breaks down the four main employment structures for OB/GYN physicians in the United States:

• Private Practice
• Academic Practice
• Hospital-Owned Practice
• County/City-Owned Practice

Dr. Miller shares her personal journey and insights gained through research, interviews, and direct experience, aiming to demystify the career options available after residency. The episode is intended to serve as a practical starting point for residents and medical students exploring potential OB/GYN career paths.

Key Discussion Points & Insights

Choosing OB/GYN and Discovering Practice Models

• Dr. Miller recounts her initial uncertainty about OB/GYN due to a narrow view of practice options, thinking only the “private practice go-go-go, no free time, always on call model” (03:30) existed.
• Realization of the diversity in OB/GYN career paths came only after job searching as a PGY4 and speaking with attendings from various models.

The Four Primary Employment Structures

1. Private Practice

Definition: Physician-owned businesses where revenue comes from clinical services; associates are typically salaried and not involved in business operations.

Pros:

• Great for those seeking high volume and hands-on experience, especially in smaller groups (10:55).
• Potential for higher earnings: "You can earn salary plus additional bonus distributions from profit left over in private practice." (13:01)
• Less cap on earning potential; productivity directly relates to income.
• Strong patient continuity.

Cons:

• High likelihood of long and unpredictable hours in small practices.

  "You will be working crazy hours... if your practice only has four other OB GYNs, that translates to either you being on call every four days or on call for one week out of every month." (15:30)

• May require self-funded tail malpractice insurance upon departure—potentially tens of thousands of dollars (18:28).
• Greater load on each physician and frequent multitasking (delivering babies, surgeries, clinics all in a day).

Notable Quote:

"If you don't want to have a boss or work for anyone else, and you are particularly entrepreneurial, eventually starting a private practice could support a work for yourself lifestyle." (10:12)

2. Academic Practice

Definition: Employed by a university or teaching hospital, combining clinical work, teaching, and often research responsibilities.

Pros:

• Residents provide support, carrying most of the “brunt of the clinical work that you would otherwise be responsible for on your own.” (21:05)
• Resource-rich settings with access to specialists and subspecialists.
• Emphasis on staying current with evidence-based practices.
• Opportunity for research, early career mentorship, and educational roles.
• University often covers tail malpractice coverage upon exit.

Cons:

• Teaching responsibilities slow down clinical workflow (e.g., longer surgeries and clinics due to education demands).
• Potential lack of continuity of care—patients may rotate among attending physicians.
• Requires added time for nonclinical tasks (lectures, evaluations, research).
• Lower base salary compared to private and hospital-owned models:

  "Although these roles are typically salaried, the base pay can be substantially lower than other employment structures." (27:30)

Notable Quote:

“Being in an educational environment forces you to stay up to date with evidence-based practice guidelines.” (22:35)

3. Hospital-Owned Practice

Definition: Physicians are employees of a large healthcare system (e.g., Kaiser, Trinity Health). Overhead and staffing handled by hospital; compensation is via salary and bonuses.

Pros:

• Higher base salary and sign-on bonuses, sometimes substantial ($15,000–$200,000 quoted) (32:50).
• Opportunities for continuity of care in systems that assign patients to specific OB/GYNs.
• Strong mentorship possible, especially in OR settings with experienced attendings.
• Hospital covers tail malpractice insurance.

Cons:

• Physicians have little control over operations; business administrators set schedules and policies:

  “The hospital admin, usually business administrators and not clinicians, set the schedules.” (36:18)

• Potentially overloaded clinic schedules (e.g., 30+ patients/day) oriented towards maximizing hospital profit.
• Departmental changes are slow due to administrative hierarchy.

Notable Quote:

“If the schedules and models in place are not supportive of the physicians when you start, it's probably unlikely that that will change as time goes on, regardless of what the clinicians have to say about it.” (39:55)

4. County/City-Owned Practice

Definition: Governed and funded by local governments to serve mostly underserved populations; e.g., NYC Health + Hospitals.

Pros:

• Enables focus on caring for vulnerable, high-acuity, underserved populations:

  “One of the biggest pros is being able to advocate for and provide safety net care for vulnerable populations.” (42:28)

• Exposure to a wide range of pathology, rapid skill development, unique clinical scenarios.
• Minimal business obligations—focus is almost entirely clinical.
• Often substantial opportunity for career advancement and leadership.
• Frequently includes resident support.

Cons:

• Lower resource settings: limited specialists, equipment, and research infrastructure.
• Less control over operations; cumbersome admin process for changes.
• Overbooking in clinics due to high demand and limited access—sometimes 30–40 patients/day (47:54).
• Unpredictable patient attendance due to social determinants affecting care access.

Notable Quote:

“Working in a lower resource setting can be both frustrating and nerve wracking, particularly when taking care of patients that might be higher risk and really do need those resources and support systems a lot more than anyone else.” (51:03)

Memorable Moments & Quotes

• On risk of burnout in small private practices:

  "If your Practice only has four other OB GYNs, that translates to either you being on call every four days or on call for one week out of every month..." (15:30)

• On the reality of high sign-on bonuses:

  "Now those are big flashy numbers, but of course keep in mind that those numbers do come with strings. Usually if you're getting offers like that, you'll have to sign a contract agreeing to stay there as an employee for a certain number of years. Otherwise they would then have to pay all of that back." (33:21)

• The impact of working with underserved patients:

  "You really do have the opportunity to make a massive impact on someone's health who may not routinely get good care or any health care at all." (42:41)

Important Timestamps

• Introduction of career path confusion: 03:30
• Definition of the four models: 08:20
• Pros/Cons of Private Practice: 10:55–19:15
• Academic Model deep dive: 20:10–28:15
• Hospital-Owned Practice model: 29:00–39:59
• County/City-Owned Practice: 42:15–52:02

Host’s Final Reflections & Advice

• Encourages listeners to use this as a foundation and seek mentorship and firsthand insights from attendings in each model.
• Emphasizes the importance of finding a role aligned with your interests and goals:

  “The more that this stuff is talked about, the more people will land jobs that are actually a good fit for their interests and goals.” (54:10)

• Urges residents and students to continue researching and connecting with those who have direct experience, even if opinions differ from her own.

Looking Ahead

Next Episode:
Part 2 will cover ways OB/GYNs can practice within these structures—generalist, hospitalist, per diem/locum roles.

Summary by:
[Podcast Summarizer, 2026]
For more resources, visit drkcmiller.com or follow @drkcmiller across social channels.