Very interesting issue with pros and cons to both sides and I think a lot boils down to personal preference. Of course, these are generalized statements - you can always find both great and not-so-great docs in each setting.
(Note: I am in the health care field. Hopefully I'm not too biased but I've gotten a good look at both sides of the table)
University setting:
Pros:
- A lot of specialization (especially in large institutions like UNC and Duke) so you can pretty much find anyone to treat almost everything. You really want to be in or have access to a UNC or Duke if you have a serious illness or an uncommon disease.
- Research - Lots of clinical trials or cutting edge research that may allow you to get access to treatments you might not get for another handful of years (or several handfuls)
- Reputation - This matters to some people (i.e. to have the "best" doctor for this or that). It is very difficult to achieve a world-class reputation unless you publish a lot of papers/articles/books and do a lot of research. Then get asked to speak at a lot of conferences. Most private practice doctors can't do this because they don't have a lab. Or hire a clinical researcher to organize it for them. But note that the level of reputation one has does not necessarily correlate with the quality of clinical care you get; sometimes a doctor is super smart AND super caring, sometimes not. But in general, most of the people employed or who trained at UNC or Duke are pretty darn smart people.
- Physician coverage - if your doctor is away on vacation/at a conference/unavailable fr what ever reason, there is always another doctor to cover for them at all hours. While all physicians (university and private practice) have this, there is usually broader coverage at the university.
Pro or con depending on your viewpoint:
- Teaching hospital. Some love it, some hate it with the constant flow of trainees (medical students, residents, fellows). There may be a lot of repetition and you see more people in a single visit than just the doctor but your case passes through multiple eyes/brains and you never know who will pick up on something that might be important to your case. Plus, younger docs might be more open-minded to different ideas or treatments. Docs also may be good at explaining things since they are forever teaching it to someone else. But turnover can be high.
- One centralized hospital system - in an ideal setting, all the care being within one system OUGHT to make it easier for docs to communicate, to get appointments, and to minimize patient costs but admittedly, this doesn't often happen. Also, you tend to get referred within the hospital system for almost everything. But neither UNC nor Duke is the best at everything, you know? They each (as do Rex and WakeMed) have their own strengths...wouldn't it be nicer to have some choice in where to be referred to?
But, it is faster to view any radiology studies done at the hospital from any computer in the hospital system as opposed to having to go to a different hospital to request a CD of the study.
Cons:
- Very long visits and often long waits for appointments
- Bad parking/high parking prices at the University (sometimes free at satellites)
- Staff that sometimes seems like they don't care since they are employed by the University or hospital and not a particular doctor.
- The politics. Actually, they are everywhere but are often less visible in a private practice setting. This can, however, affect who you get referred to or what hospital you
Private practice setting:
Pros:
- Service is usually better and faster, partly because you are often free to walk away if you are dissatisfied (whereas a referral practice at a University practice often has a captive audience), hurting the practice.
- Free parking!
- Nicer, more updated offices (usually)
- More stability in staff and doctors
- May have more flexible hours like early morning or evening hours, or Saturday hours (the Universities cannot or will not pay overtime for these hours)
Pro/con:
- Amount of time spent per patient. This is really variable. Primary care doctors (internal medicine, family practice, pediatrics) may be able to give you more time initially and it may or may not continue. Other doctors might spend even less time with you because the more patients they are able to see, the more money they make (or rather, try to break even....most doctors need to see 25+ patients in a day to break even). It may just feel like you see them more if you haven't spent 3 hours waiting for them to begin with!
Cons:
- Every doctor is required to do a certain amount of continuing medical education (CME) every year (actually every 3 years in NC) but it can be hard to fit into the schedule and they may only do their CME in one lump every couple years. So it can be easy to get into a groove and just do what they were taught
x number of years ago. It may not be the latest and greatest whereas docs in the University settings tend to be more up to date.
- It can be hard to figure out who is good until you've gone through the experience with them. And if you are dissatisfied with the service or your care, you don't have much recourse (aside from not going back or going to the state medical board if there was gross negligence)
- More fees. Typically a private practice will charge you fees such as to refill prescriptions outside normal working hours, fill out forms or paperwork, copying your medical records, missed appointments, etc. To be fair, this is uncompensated work (by insurance) and forms are not always easy to fill out (try filling out 20+ different 10 page forms or letters every few days, always needed ASAP!).
Conclusion:
In general, I think that UNC and Duke satellite offices try to function like a private practice with the benefits of the larger hospital system with varying degrees of success. Rex and WakeMed are already just private practices affiliated with the hospital so you might get the efficiency of private practice but each practice interacts with the hospital differently so your experience might be different as opposed to the uniformity of the university hospital experience.
Overall I think a lot of it depends on how you want your care to be handled. If you want a specialist or the "world class" doc treating each condition with the depth of experience and knowledge that goes with it (for example, a cardiologist for your heart disease, endocrinologist for diabetes, orthopedic surgeon/PMR doc for your back pain) but probably a more fragmented experience of care, requiring YOU to be in charge of your care and coordinating it then go with a UNC or Duke. Otherwise you are likely more satisfied with a private practice experience but it can very difficult to find the right fit.
I could go probably on but I won't. Kudos to anyone who made it through the whole post!
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