Academic vs Private Practice: A DO Graduate's Guide to Global Health

Understanding Your Options: Academic vs Private Practice in Global Health

As a DO graduate interested in global health, you’re facing two major questions at once:

1. How to shape your early career after residency, and
2. Where you can have the greatest impact—academia or private practice.

For many osteopathic physicians, the reality is that global health work can be built from either setting, but the path, day‑to‑day structure, and long‑term career trajectory look very different.

This article breaks down what academic medicine and private practice actually look like for a DO graduate in global health, how each setting supports (or constrains) your international medicine aspirations, and how to make a strategic decision that fits your goals, finances, and lifestyle.

We’ll assume you have completed (or are about to complete) residency—perhaps with an osteopathic residency match that exposed you to underserved populations, global health electives, or a global health residency track. Now you’re deciding what comes next.

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Core Differences: How Academic and Private Practice Careers Are Structured

What “Academic Medicine” Usually Means

In most settings, an academic medicine career means you are employed by:

• A university or osteopathic medical school
• A teaching hospital or large health system
• A research institution affiliated with a residency or fellowship program

Your work is typically divided among:

• Clinical care – Seeing patients in hospital and/or clinic
• Teaching – Medical students, residents, and sometimes fellows
• Scholarship – Research, quality improvement, grants, publications, or educational projects
• Service – Committee work, curriculum development, global health program building

For a DO graduate with global health interests, academic environments often offer:

• A more direct pathway to global health faculty roles
• Structured time and funding—at least potentially—for international medicine projects
• Access to institutional partnerships abroad and global health residency tracks

What “Private Practice” Usually Means

Private practice can range from:

• Solo practice or small group practice in the community
• Larger multi‑specialty groups
• Private hospital‑based employed positions
• Hybrid models tied loosely to academic centers

In private practice, the focus is usually:

• High clinical volume – More patients, more procedural work, more RVU‑based productivity
• Business operations – Revenue cycle, overhead, contracts, coding, and efficiency
• Less formal teaching/research – Though some practices do host students or participate in clinical trials

For a DO graduate interested in global health, private practice can:

• Provide higher earning potential and more control over scheduling
• Require more deliberate planning to integrate short‑term medical trips, telehealth consults, or NGO work
• Offer flexibility to design your own international commitments once practice is stable

How Your DO Background Fits In

As a DO graduate, you bring unique strengths to either path:

• Training in whole‑person care and social determinants of health
• Comfort with interdisciplinary, team‑based care
• Skills in Osteopathic Manipulative Treatment (OMT) that can be highly useful in low‑resource settings where diagnostics and pharmaceuticals are limited

Both academic and private settings may value these skills differently. Academic centers may lean into your ability to teach OMT and holistic care; private practice may see OMT as an added revenue stream or a niche service line.

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Academic Medicine for DOs in Global Health

Academic medicine tends to be the most visible and structured route for a DO graduate who wants a career infused with international medicine. But the reality is more nuanced than “academics = global health job.”

Typical Academic Roles with a Global Health Focus

Common positions include:

• Assistant Professor in Global Health / Family Medicine / Internal Medicine
  Clinical responsibilities plus protected time for global health electives, curriculum development, or research.

• Global Health Program Director or Associate Director
  Overseeing a global health residency track, electives abroad, and international partnerships.

• Hospitalist or Specialist with Global Health Portfolio
  Majority of time in clinical care, with 10–30% time allocated to global health teaching, research, or field work.

• Clinician‑Educator with International Focus
  Heavy teaching role, simulation, curricula for international medicine, and mentoring trainees interested in global health.

Advantages of Academic Medicine for Global Health

1. Structured Global Health Residency Track and Fellowships
   If you trained in or now join a program with a global health residency track, you gain:

   • Mentorship from faculty active in global work
   • Access to well‑established partner sites abroad
   • Funding mechanisms, grant writing support, and risk management systems
   • Clear guidelines for supervision, licensure, and safety

2. Protected Time (At Least on Paper)
   Contracts may include:

   • “X% FTE for global health program development”
   • “Y half‑days per month” for international collaborations or research
   • Dedicated time for global health curriculum, simulation, and scholarly output

   Note: Protected time is negotiated, not automatic. You must advocate for it.

3. Institutional Support and Infrastructure

   Academic centers often provide:

   • IRB support for global research
   • Grants office help for funding proposals
   • Legal and risk frameworks for supervising trainees abroad
   • Administrative support for memoranda of understanding (MOUs) with international partners

4. Career Advancement and Recognition

   Working in global health within academia often translates into:

   • Promotion portfolios that include global health teaching and scholarship
   • Opportunities to present at conferences and publish
   • National and international recognition as a global health expert, which can open doors for leadership roles

5. Opportunities for Systems‑Level Impact

   Through academic roles, you can:

   • Influence curriculum to integrate international medicine and health equity
   • Shape institutional policies around global engagement, ethics, and bidirectional partnerships
   • Mentor the next generation of DOs interested in global health

Challenges of Academic Medicine for DO Graduates

1. Lower Income Relative to Private Practice

   While salaries vary by region and specialty, academics often pay:

   • 10–40% less than comparable private practice roles
   • Academic bonuses tied more to RVUs and scholarly productivity than to raw clinical volume

   For a DO graduate with educational loans, this pay gap can be significant, at least early on.

2. Pressure to Balance Clinical Work and Scholarship

   Many junior faculty find:

   • Clinical demands quickly expand to fill your schedule
   • “Protected time” gets encroached upon by service needs
   • Global health projects must still produce tangible outputs—papers, grants, programs—to be valued for promotion

3. Complex Institutional Politics

   Global health structures may be:

   • Fragmented across departments (medicine, pediatrics, surgery, public health)
   • Underfunded or competing with other institutional priorities
   • Shaped by legacy partnerships that may not align with your specific interests

4. Less Flexibility in Location and Schedule

   Academic roles are often tied to:

   • Specific campus locations
   • Set clinic and teaching schedules
   • Lengthy approval processes for field work or extended time abroad

Best‑Fit Profiles for Academic Medicine in Global Health

Academic medicine is often a strong fit if you:

• Enjoy teaching and mentoring as much as seeing patients
• Are motivated by research, program building, or policy change
• Want a long‑term academic medicine career with promotion and leadership
• Value being part of a team that includes MPH, PhD, and public health colleagues
• Are comfortable with modestly lower pay in exchange for institutional support and career development

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Private Practice in Global Health: Building an Unconventional Path

Private practice might not immediately seem compatible with global health, but for a DO graduate it can be a highly effective platform—if you are intentional about designing it.

Models of Private Practice with Global Health Components

1. Domestic Practice + Periodic International Work

   • High‑volume U.S. practice for most of the year
   • 1–3 trips per year for clinical care, formal partnerships, or teaching abroad
   • Vacation time, unpaid leave, or flexible scheduling used to accommodate trips

2. Part‑Time Practice + NGO / Telehealth Work

   • 0.6–0.8 FTE in a private group or hospitalist role
   • Remaining time for:
     • Work with an international NGO
     • Global telemedicine consults
     • Training and capacity building with partners abroad

3. Mission‑Driven Community Practice with Global Links

   • Clinical practice in underserved U.S. communities
   • Formal connections with clinics in low‑resource countries
   • Bidirectional exchanges—host visiting clinicians, send staff/learners abroad

4. Hybrid Roles Tied to Academic or Nonprofit Entities

   • Clinical employment by a private group
   • Adjunct or volunteer faculty appointment to participate in:
     • Global health electives
     • Teaching international medicine topics to residents
     • Collaborative research or quality improvement across borders

Advantages of Private Practice for Global Health

1. Higher Compensation and Faster Loan Repayment

   Private practice can offer:

   • Higher base compensation, productivity bonuses, and profit‑sharing
   • Ability to use higher income for:
     • Aggressive student loan payoff
     • Funding your own global health projects or travel
     • Donating to partner institutions abroad

2. Greater Autonomy and Flexibility

   In many settings you can:

   • Negotiate call schedules and vacation time
   • Build in extended blocks of time for international work (2–4 weeks)
   • Choose clinical focus areas that align with your global health interests (e.g., maternal health, infectious disease, trauma)

3. Entrepreneurial Opportunities

   You can:

   • Create partnerships with NGOs or clinics abroad
   • Develop telehealth links between your practice and international sites
   • Innovate around low‑cost care models, digital health, or training programs that cross borders

4. Sustainability Over the Long Term

   A financially strong private practice can:

   • Support you in doing long‑term, recurring work with a single community or region
   • Fund visiting scholars, training programs, or equipment donations in a more predictable way

Challenges of Private Practice in Global Health

1. Limited Structural Support

   Private practices rarely provide:

   • Protected time for global health work
   • Institutional grants or global health residency tracks
   • Administrative staff to coordinate partnerships abroad

   Most global health activity must be self‑initiated and self‑managed.

2. Schedule and Coverage Constraints

   Extended trips may be difficult when:

   • You are needed in clinic or OR to maintain revenue
   • Partners are reluctant to cover call or inpatient responsibilities
   • Travel requires unpaid leave that impacts your annual income

3. Perception and Credentialing

   • Without academic titles, you may be less visible for certain global health leadership roles or academic collaborations.
   • You may need extra effort to build credibility in academic or policy circles.

4. Risk of Burnout

   Combining:

   • Full‑time, high‑volume private practice
   • Repeated, intense short‑term international trips

   can lead to physical and emotional fatigue, especially without adequate support and rest.

Best‑Fit Profiles for Private Practice in Global Health

Private practice may be a strong fit if you:

• Prioritize higher income and financial stability early on
• Are comfortable being self‑directed and entrepreneurial
• Want to choose your own regions, partners, and projects
• Prefer clinical volume and procedural work with intermittent global engagement
• Are less interested in publications and academic promotion, but very interested in hands‑on service and collaboration

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Key Factors in Choosing Your Career Path in Medicine

When comparing private practice vs academic pathways, especially with a global health lens, a few decision domains matter most.

1. Your Long‑Term Vision in Global Health

Ask yourself:

• Do I want to lead programs, publish research, or influence policy in global health?
  → Academic medicine may be more aligned.

• Do I see myself working clinically abroad for extended periods?
  → Academic global health fellowships or NGOs might be better than private practice initially.

• Do I want to build a stable U.S. base while doing recurring short‑term work abroad?
  → Private practice with intentional scheduling can work well.

2. Financial Priorities and Debt Burden

Consider:

• Your current loan balance and interest rate
• Your need to support family or other financial responsibilities
• The impact of:
  • Higher academic job satisfaction vs. lower pay
  • Higher private practice income vs. less structured global health support

Some DO graduates choose a hybrid timeline:

• First 5–7 years: private practice, high income, aggressive loan repayment
• After loans are manageable: transition to an academic medicine career with explicit global health time and lower pay tradeoffs

3. Tolerance for Bureaucracy vs. Entrepreneurship

Academic medicine:

• More committees, policies, promotion criteria
• More structured mentorship and defined roles

Private practice:

• More business considerations and self‑management
• More direct control of your time, but less built‑in support

Neither is inherently better; the question is which environment energizes you rather than drains you.

4. Lifestyle and Family Considerations

Factors to weigh:

• How often you realistically can or want to travel abroad
• Impact of travel on partners, children, or aging parents
• Night call, weekend work, and holiday coverage at each job
• Flexibility to relocate as global opportunities arise

Global health often sounds exciting early in training; a realistic plan must integrate the needs and preferences of those closest to you.

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Practical Steps for DO Graduates Deciding Between Academic and Private Practice

Step 1: Clarify Your 5–10 Year Global Health Goals

Write down:

• What kind of work abroad you actually want:
  Clinical care? Teaching? System design? Policy? Research?

• How much time per year you hope to be physically present abroad:

  • 1–2 weeks?
  • 1–3 months?
  • Full‑time for several years?

Your answers directly affect which setting is more realistic and sustainable.

Step 2: Explore Positions That Explicitly Mention Global Health

For academic roles, look for:

• Job postings with phrases like:
  • “global health residency track”
  • “international medicine”
  • “tropical medicine”
  • “health equity and global partnerships”
• Institutions with:
  • A global health office or center
  • An MPH or public health school on campus
  • Active global health electives for students and residents

For private practice roles, ask explicitly:

• Does anyone in the group currently do international work?
• How do they handle extended absences or unpaid leave?
• Would the group be open to:
  • Hosting international visitors?
  • Participating in telehealth links or training programs?

Step 3: Negotiate Global Health into Your Contract

For academic positions:

• Ask for:
  • A specific percentage of FTE for global health activities
  • Dedicated travel funds (CME, institutional, or grant‑linked)
  • Clear expectations: number of weeks abroad, teaching vs research

For private practice positions:

• Negotiate:
  • Guaranteed blocks of time off (e.g., 3–4 weeks consecutively once or twice yearly)
  • Clear policies for unpaid leave, if needed
  • Flexibility in scheduling around global health commitments

Put these terms in writing. Goodwill alone is not sufficient.

Step 4: Build Your Network in Both Worlds

Regardless of setting:

• Join relevant organizations:

  • American Osteopathic Association (AOA) sections on global health
  • American Academy of Family Physicians Global Health, ACP global health groups
  • Specialty‑specific global health consortia

• Attend:

  • Global health conferences
  • Academic talks on international partnerships
  • NGO or mission organization information sessions

You can be in private practice and still hold voluntary academic appointments or NGO roles that deepen your international engagement.

Step 5: Reassess and Pivot as Your Career Evolves

You are not locked into one path forever:

• DO graduates in private practice can later move into academic medicine, especially if they:
  • Maintain teaching connections
  • Participate in scholarly or programmatic work
• Academic global health physicians may later transition to:
  • NGO leadership
  • Policy or governmental roles
  • International full‑time positions

Revisit your goals every 3–5 years and adjust your career path in medicine accordingly.

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FAQs: Academic vs Private Practice for DOs in Global Health

1. Is academic medicine the only way to have a serious career in global health?

No. Academic medicine often provides the most structured path and formal recognition, but many impactful global health leaders work through:

• NGOs and nonprofit organizations
• Government agencies and international bodies
• Faith‑based organizations
• Long‑term clinical positions abroad

Private practice can be a powerful financial and logistical base, especially if you intentionally cultivate partnerships and build a track record of consistent, ethical engagement.

2. As a DO graduate, will I face barriers in academic global health roles?

In most U.S. academic centers, DOs are fully integrated into faculty roles, including global health. Potential barriers are more likely to be:

• Specialty biases (e.g., in certain competitive subspecialties)
• Limited awareness of the DO degree internationally

You can mitigate this by:

• Highlighting your osteopathic training in whole‑person care
• Demonstrating scholarly productivity (presentations, QI projects, publications)
• Obtaining additional credentials if aligned with your goals (e.g., MPH, DTM&H)

3. Can I switch from private practice to academic global health later?

Yes, many physicians do exactly this. To keep the door open:

• Maintain involvement in:

  • Teaching (students, residents, or visiting trainees)
  • Quality improvement or data‑driven projects
  • Global health collaborations with clear, documentable outcomes

• Keep your CV updated with:

  • Global health work
  • Volunteer leadership roles
  • Any research or educational contributions

Academic recruiters will look for evidence that you can contribute to teaching, scholarship, and institutional global missions.

4. How do I avoid short‑term “voluntourism” and build ethical global health work from either setting?

Focus on:

• Long‑term partnerships, not one‑off trips
• Local leadership and priorities—supporting what communities say they need
• Capacity building—training, systems, mentorship—not just direct care
• Reflection and feedback from local partners on your role and impact

Whether you are in academic medicine or private practice, the most respected global health work is reciprocal, sustainable, and grounded in equity, not in brief, unsupervised clinical experiences abroad.

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Choosing between academic and private practice as a DO graduate in global health isn’t about which path is “right,” but about which one best aligns with your values, financial reality, and vision for impact. With clear goals and intentional planning, you can design a meaningful global health career from either side of the academic–private practice divide—and you can always evolve your path as you and your circumstances change.