A Love Letter to My Workplace: An Ethical Model of Private Practice for Clinician and Patient Well-Being

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In October 2022, I was completing my addiction psychiatry fellowship and searching for a position that aligned with my needs and values. I wanted flexible scheduling, remote work, reasonable vacation time, competitive pay, and the opportunity to focus on addiction and reproductive mental health. Yet, after countless interviews, I felt disillusioned. The rigidity of traditional health care settings—whether large hospital systems or academic institutions—left me doubting whether I could find a job that truly fit my needs.

Like many clinicians, I found traditional health care settings too restrictive and limiting. Large hospital systems felt stifling, and academia never appealed to me. I needed a job where I had autonomy, excellent support staff, and the flexibility required as a mother. More than anything, I had an almost primal need to be physically near my child. During fellowship, I spent a year away from her on most days, and it was painful. The pandemic underscored how much I prefer remote work (and showed me that it was an option). Beyond that, I hate commuting. I had already spent 4 years of residency and an extra year for my fellowship losing hours each day to the drudge of driving, packing lunches, and squeezing into uncomfortable professional clothing. By then, Lululemon Align yoga pants had become my everyday uniform, and I was not ready—and still am not ready—to give them up.

Desperate, I turned to a Facebook group for private practice psychiatrists, posting my ideal job criteria. A few responses came in, but they all required significant compromises—until Brittany Albright, MD, MPH, reached out.

A Practice Designed for Moms Who Are Also Real People

When Brittany and I connected over Zoom, she immediately apologized for wearing sweats because it was her admin day. Then she started telling me about her practice. I will never forget what she said next—words I had never heard from a potential employer: “We are all moms here.”

I was flabbergasted. It was the most refreshing thing I had ever heard. With those 5 words, Brittany communicated something profound: I would be surrounded by individuals who understood and would support the demands of motherhood.

Brittany’s practice operates on a simple but radical premise: happy, supported clinicians provide excellent care. She built a structure that allows providers to set their schedules and emphasizes work-life balance. There are no rigid vacation policies or unrealistic patient quotas. Clinicians are trusted to manage their time and caseloads effectively.

Unlike many employers who dance around financial discussions until the final stages of hiring, Brittany laid everything out: reimbursement rates, revenue splits, and contract details. She could not offer traditional benefits, but she was willing to pay for my South Carolina license if I agreed to stay for a year. I would be a 1099 contractor, meaning I would get paid only when the practice was paid—whether by patients or insurance companies, which can take months. But I would have autonomy and flexibility. Brittany understands what many employers with high turnover rates do not: happy clinicians do not want to leave their jobs.

Ethics were at the core of the practice’s foundation. There was no noncompete clause, as patients should choose which doctors they see and clinicians should be free to work where they choose. Rather than opting for a lucrative cash-pay-only, the practice navigated the complexities of insurance to ensure accessibility for patients who rely on their coverage. That decision meant a larger administrative and billing team, more financial challenges, and additional stress—but it also upheld the ethical commitment to making care available to those who needed it most.

More Than a Job: A Sustainable Model for Private Practice

Two years later, I can confidently say that this practice is more than just a job—it is a community. The level of support I have received, particularly during life’s unpredictable moments, has been invaluable. When I unexpectedly gave birth 3 weeks early, my colleagues immediately stepped in to help reschedule and see patients. When I needed to adjust my schedule for personal reasons, no one questioned my commitment or work ethic. No one is micromanaging me or breathing down my neck to see more patients with less time. This flexibility has allowed me to be a better clinician and a better mother.

More importantly, this model proves that a sustainable, ethical private practice is possible. Many clinicians avoid private practice due to financial risks, administrative burdens, and a lack of business training. Yet, under the right leadership, a practice can be structured to provide both physician autonomy and patient-centered care. While not every clinician has the financial resources or support network to build a practice from the ground up, models like this demonstrate that change is achievable with the right priorities in place.

Why Aren’t There More Practices Like This?

I often wonder why more practices like this do not exist. When I ask Brittany, she is candid: “We operate on slim margins.” The financial realities of running a small, insurance-based practice make it difficult to replicate at scale. Many (if not most) clinicians graduate with overwhelming student debt, making private practice financially unfeasible. Big hospitals can negotiate better deals, but smaller practices often get left behind. When insurance companies underpay, it becomes difficult to keep a practice afloat, let alone repay the hundreds of thousands of dollars in student loans that many of us carry. Furthermore, the complexity of running a private practice often deters clinicians from considering it as a viable option. Many doctors lack formal training in business management, billing, and navigating insurance systems. Without guidance or mentorship, stepping into private practice can feel daunting.

At the same time, the practice is self-sustaining in part thanks to her valiant efforts. Additionally, she has leveraged her unique advantages: her father, an accomplished maternal-fetal medicine doctor, helps administer esketamine (Spravato) treatments that subsidize the practice; she was lucky to have manageable student loans. She started the practice before 2020 when financial conditions were different. She was able to invest most of her earnings back into the practice, and their family lived off her husband’s income for several years. She also acknowledges that not everyone has a family member like her dad willing to work for low pay to support their vision.

But I have a hard time accepting that answer. Big corporate hospital systems would not be interested in Brittany’s model—it is sustainable but not maximally profitable. But you know who would be? Doctors. Brittany is not the only clinician with unique advantages allowing the creation of this practice model. Clinicians enter medicine to provide excellent care, not to be overworked and under-supported in a system that treats them as replaceable. Burnout remains a crisis in health care, and the rigid structures of traditional employment often exacerbate the problem. Student loan debt certainly complicates motivations, but golden handcuffs—even ones that allow a superficially lavish lifestyle—feel just as restrictive as iron. Too many doctors lose their joy in medicine and with their patients because they are treated like widgets and squeezed by hospital systems that strip away their autonomy and fail to accommodate their family lives.

What if more of us had the opportunity to work in practices like Brittany’s—where we were not forced into being rigid and robotic “provider” boxes, constantly asked to do more with less, and denied the time we need for our health and families? What if we were instead part of a community of professionals supporting one another at different life stages with a shared mission: to provide excellent, holistic patient care; support one another; and practice ethically?

As a woman in medicine, I desperately need more leaders like Brittany.Her practice proves that a different model is possible—one where clinicians have autonomy, support, and the ability to care for themselves and their families without sacrificing patient care. This is not just about 1 exceptional leader; it is about rethinking how medicine can and should be practiced.

The Future of Medicine Needs More Ethical Leaders

If more clinicians had the opportunity to work in settings like this—where ethical care is prioritized over profit, and flexibility is seen as a necessity rather than a perk—perhaps fewer would leave the field due to burnout.

The future of medicine needs more leaders willing to challenge the status quo. More practices that center both patient and provider well-being. More clinicians will be empowered to create sustainable, ethical workplaces.

While financial and systemic barriers remain, some steps can be taken to encourage more ethical private practices. Improving reimbursement rates for independent practitioners, reducing administrative burdens, and providing mentorship programs for those interested in starting their practices could all help facilitate change.

We cannot accept burnout as an inevitability. We must demand better—for ourselves and our patients. Medicine can and should be practiced in a way that honors both the clinicians and the communities they serve. By embracing ethical leadership and innovative practice models, we can work toward a future where clinicians thrive and patients receive the compassionate care they deserve. It just takes 1 innovative leader to show the rest of us how it is done.

Dr Gritti is an adult, addiction, and perinatal psychiatrist. She works for a private practice in Mount Pleasant, SC.