Should I take a hospital employed OB/GYN job or join a private group?

Take the employed job when its carried costs and loan benefits outweigh the group ownership path in your market, and take the group when its distributions and equity clear those carried costs by a margin you can verify in writing. In this specialty, employment is a malpractice decision. The hospital carries the premium, usually carries the tail, and often keeps a Public Service Loan Forgiveness count running. The private group hands you the specialty's upside and its largest bills along with it. Price both models where you will actually practice.

Part of the OB/GYN hub.

What the employed job really pays

The salary is the visible part, and the anchors are strong. AMN Healthcare reports an average starting salary for obstetrics and gynecology of $374,000, with average offers by region running from $350,000 in the West to $446,333 in the Southwest. Medscape reports average OB/GYN compensation of $390,000. An employed offer near those anchors is competitive before you count anything else.

Then count what the hospital carries. The AMA reports the premium for a $1M/$3M OB/GYN policy at $49,804 a year in Los Angeles and Orange County, $135,974 in Philadelphia, $207,907 in Cook, Madison, and St. Clair counties in Illinois, and $243,988 in Miami Dade. An employed physician pays none of that directly, in any of those markets. The tail usually travels with the institution program as well, and at 150 to 200 percent of the mature premium that is a second carried cost worth $365,982 to $487,976 on the Florida figure alone, because $243,988 times 1.5 is $365,982 and $243,988 times 2 is $487,976. Add the employee layer on top: a retirement match, funded coverage, paid leave, and a benefits office that administers all of it.

The loan line can decide the comparison by itself. Many in this specialty work for nonprofit systems, and Public Service Loan Forgiveness follows the employer that pays you. A physician carrying the median education debt of $200,000 from the AAMC class of 2025, working full time for a qualifying nonprofit hospital, is running a count toward forgiveness after 120 qualifying payments. Heidi, the new attending in the Heidi and Spencer case, is doing exactly that: about $280,000 of debt, 24 of 120 payments made, employed in Portland at about $320,000, with her employer carrying her tail and an attorney having reviewed her contract before she signed.

What employment does not give you is a share. The ceiling is the salary band, the call structure is set by the system, and the equity at exit is zero, however long you stay.

What the private group really pays, and really charges

The group pays in three currencies the hospital does not offer. Production pay rewards a full panel and a full surgical schedule with no band above it. Distributions share the whole practice's collections in strong years. Ownership adds an exit, a buy sell formula that pays for your share when you leave or retire. For a physician who builds a busy practice and stays, those three together can pass any employed package across a long career, and the partners also govern the place: call structure, staffing, and premium strategy are voted on by the people who live with the results.

The charges arrive in the same three currencies, reversed. Your share of the premium comes out of the collections that fund distributions, and it is one of the practice's largest overhead lines, at the market figures above. The buy in is paid early, in the years when a new attending household can least spare the cash. The tail is assigned by the group documents at every exit, and it prices off the same premium band: in California, $49,804 times 1.5 is $74,706 and $49,804 times 2 is $99,608, while in Florida the same formula reaches the $365,982 to $487,976 range already shown. Income also moves with payer mix, collections, and the group's claims years, and a small group spreads each shock across fewer shoulders.

So the comparison is a subtraction problem in your market. Group side: expected distributions after overhead, plus equity at exit, minus your premium share across the years, minus the buy in, minus a tail accrual. Employed side: salary across the years, plus the premium and tail you never pay, plus the match and benefits, plus the forgiveness value if your count is live. Run both across ten years rather than one, because the group case is built on later years and the employed case is strongest early, when debt is high and the carried costs do the most work.

Follow up questions

I have large loans. Does that settle it for the employed job?

It points hard that way, and the math is the reason. Forgiveness after 120 qualifying payments at a nonprofit employer can be worth more than a private group distribution edge in the first decade, especially in a high premium market where the group also charges you for coverage. The exception is a group that is itself part of a qualifying structure, which is rare, so verify the employer of record rather than assuming either way.

Can I start employed and join a group later?

Yes, and many physicians sequence the models that way: employed years first, while the loan count runs and reserves are built, then a group move with the buy in priced as a fresh cost. Protect the bridge: confirm your tail treatment when you leave the employed job, read the covenant for any bar on joining a local group, and keep your procedure volume documented.

What should I ask the group that I would not ask the hospital?

Ask for the numbers an owner lives on: distributions for partners at your expected production over the last three years, the premium the group actually paid last year and who bore it, the buy in formula, and the tail treatment for every partner who has left. A group should answer with its books, in writing, before you sign.

Related questions

• How does laborist shift pay compare with private practice over a career?
• Large group for malpractice coverage or small practice for ownership?
• Should a new OB/GYN join a partnership track practice?

Sources

American Medical Association, Policy Research Perspectives, medical liability premiums (reported $1M/$3M OB/GYN premiums from $49,804 in Los Angeles and Orange County to $243,988 in Miami Dade, accessed October 2026)

AMN Healthcare, 2026 Review of Physician and Advanced Practitioner Recruiting Incentives (average starting salary of $374,000 and regional average offers from $350,000 to $446,333, accessed October 2026)

Medscape Physician Compensation Report 2026 (average OB/GYN compensation of $390,000, accessed October 2026)

Association of American Medical Colleges (median education debt of $200,000 for the class of 2025, accessed October 2026)

Federal Student Aid, Public Service Loan Forgiveness (forgiveness after 120 qualifying monthly payments while working full time for a qualifying employer, accessed October 2026)

Takeaways

• The employed job carries the premium, from $49,804 a year in California to $243,988 in Miami Dade, and usually carries a tail worth $365,982 to $487,976 on the Florida figure.
• Employment at a nonprofit system keeps a Public Service Loan Forgiveness count running, which can decide the first decade by itself.
• The private group pays in production, distributions, and equity at exit, and charges a premium share, a buy in, and an assigned tail.
• Run the subtraction across ten years in your market. The group case rests on later years, and the employed case is strongest early.