Working for a Large Hospital System: Weighing the Pros and Cons

I’ve always fancied myself a small hospital or independent clinic kind of girl. My first nurse practitioner jobs were in walk-in and urgent care clinics where I interacted with the physician owners almost daily. Any question or concern I had went straight to the top of the administration chain. Or, rather, there was no chain.

Over the past few years, however, I’ve been employed in the the emergency department of a hospital that’s part of a much larger, national healthcare network. The daily vibe is much different than in my small practice days. Some of this can be accounted for by the fact that the setting in the emergency department isnaturally much different than that of urgent care, but many of these workplace differences have to do with the size of my employer. Working in a large hospital system certainly has its benefits and drawbacks.

If you’re thinking about taking a nurse practitioner or physician assistant job in a large hospital network, here are a few of the pros and cons I’ve personally noticed.

Pro: Being Part of the Bigger Picture

Working in a larger hospital, and one that is part of a network, exposes you to multiple other medical providers from multiple specialties. In the ER, for example, I interact with orthopedists, surgeons, and neurologists and their NP colleagues. Each specialist has something to share. Access to advanced testing and knowledge gives me an unmatched opportunity to grow in my clinical skills.

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Pro: Exposure to Multiple Opinions

When I worked in a smaller clinic, I had one or two docs to approach with questions. Now, working with a larger employer, I have 9 or 10 collaborating physicians’ opinions to consider. While this is occasionally frustrating, everyone does things differently, getting a variety of perspectives allows me to take away the best practices from each perfecting my own approach to interacting with patients.

Pro: Flexibility within Your Position

Large hospital systems have multiple locations, multiple NP ad PA positions, and often many healthcare providers working in the same position. This gives you options when it comes to your day to day schedule. Larger employers are more likely to offer a variety of shift times or have someone to cover your position if you want to take a vacation. Should you decide to relocate, you may be able to switch physical work locations without the hassle of changing your employer. You may even be able to transition to working in a different specialty for the same company.

Pro: Potential for Upward Mobility

Interested in a career in healthcare administration? If you can see yourself working as a nursing supervisor or medical director of some sort, working for a larger hospital system, or at least larger employer, is the place to be. Big organizations are capable of promoting nurse practitioners and physician assistants into managerial or administrative roles. This option is a perk should you foresee yourself branching out from clinical practice.

Pro: Extra Perks

Larger employers often offer small conveniences that can add up to make a difference in your day to day. Big hospital systems may have affiliated daycares making child care drop off a cinch. A cafeteria means you don’t go hungry should you forget to pack a lunch.

Perks can be even larger adding up to thousands of dollars in value. Employees of hospital systems may receive healthcare at a discounted rate, a benefit that quickly adds up financially. University hospitals may also offer tuition benefits for children of employees attending affiliated schools.

Pro: Better Benefits

Larger employers, typically (but not always) offer better benefit packages than their smaller counterparts. Health insurance offerings and retirement plan options are more robust with larger companies. Be cafeful here, however. Some small employers pay higher salaries to compensate for providing fewer benefits. Look at the value of all packages you are offered to see which is more attractive for you and your family.


Now for the negatives…


Con: Politics, Politics, Politics

Larger hospital systems are riddled with red tape. This prevents decisions from being made quickly and requires you to adhere to strict processes. While the hierarchy of a large organization provides structure, it can be a bear to deal with. Making your voice heard may be difficult.

Con: Getting Things Done Takes Time…a Long Time

Getting anything done on an administrative level or even day to day level can be a major drag. The larger the employer, the more slowly the organization moves. This affects your job on both macro and micro levels. Personally, I have been trying to get my printer fixed for a month now with little to no response from my hospital’s IT 1-800 number. The process of calling a 1-800 number to reach someone working for the same employer can really bog down your workday.

Con: Your Successes May Go Unnoticed

We all want to perform well on the job. Whether we learn to tie a new suturing knot or have the best door-to-greet times on the ER team, it’s nice to get some props when it comes to doing your job well. When you work within a large hospital system, administrators and managers are looking at things on a larger scale. This can make your small wins seem insignificant.

Con: It’s All About Numbers

Medical practices small and large all look at the bottom-line. Like it or not, medicine is a business. A viable practice, be it a mom and pop primary care clinic or the largest hospital network in the nation, needs to make money. Larger hospitals tend to track metrics closely. They’re all about numbers. Be it monitoring wait times, tracking supplies, or counting the minutes you spend in the restroom, larger employers study metrics closely. This can make your practice seem more like a patient mill rather than a place where you can offer helpful advice and promote wellness.


Do you work for a hospital system? What do you see as the positives and negatives of working for a large employer?


Are you looking for a nurse practitioner or physician assistant job? Whether you see yourself working in a private practice or for a large employer, ThriveAP Career Advisors can help. Email if you could use some assistance in your job search.


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