Choosing Between Academic and Private Practice for DO Pediatrics-Psychiatry Grads

Understanding Your Unique Starting Point as a DO Triple Board Graduate

Finishing a Pediatrics–Psychiatry–Child & Adolescent Psychiatry (often called peds psych residency or triple board) program places you in a uniquely versatile position in medicine. As a DO graduate, you bring an osteopathic lens—holistic, systems-oriented thinking—that is especially valuable in caring for children and families with complex medical and behavioral health needs.

As you transition into the post-residency and job market phase, one of the most consequential decisions you’ll make is whether to pursue:

• An academic medicine career, or
• Private practice (solo or group), or
• Some hybrid role combining elements of both.

This decision is about much more than salary. It affects your daily schedule, clinical focus, intellectual life, geographic flexibility, research and teaching opportunities, and long-term career identity. For a DO graduate in peds-psych, the trade-offs are nuanced because your skill set intersects pediatrics, psychiatry, systems of care, and family-centered practice.

This article walks through those trade-offs in depth, with a focus on choosing a career path in medicine that fits who you are now—and who you may want to become in 5, 10, or 20 years.

We’ll explore:

• How academic and private practice settings differ for triple board–trained DOs
• Day-to-day life in each environment
• Compensation, lifestyle, and practice flexibility
• How this choice shapes your academic medicine career potential and long-term options
• Practical decision frameworks and negotiation tips

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Academic Medicine in Peds-Psych: What It Really Looks Like

Academic medicine is more than “hospital-based practice.” It typically includes a medical school or university affiliation, formal teaching roles, and often at least some research or scholarly activity. For a peds-psych DO graduate, it can be a particularly natural fit.

Core Features of an Academic Pediatrics–Psychiatry Role

Typical components of an academic position for a triple board–trained DO:

1. Clinical work

   • Inpatient child and adolescent psychiatry units
   • Pediatric consultation-liaison psychiatry (peds hospital + psych interface)
   • Outpatient integrated behavioral health in pediatric clinics
   • Developmental-behavioral pediatrics or complex care clinics
   • Specialty clinics (e.g., autism, eating disorders, neurodevelopment, high-risk perinatal)

2. Teaching and supervision

   • Medical students (MD and DO), pediatric residents, psychiatry residents, triple board residents, fellows
   • Interprofessional teaching (psychology interns, social work trainees, nurse practitioners)
   • Bedside teaching, didactics, case conferences, OSCEs, simulation labs

3. Scholarly activity

   • Clinical research, quality improvement, implementation science
   • Education scholarship (curriculum development, assessment tools, educational research)
   • Presentations at national meetings (AACAP, AAP, AOA/ACOI, AAAP, etc.)
   • Writing review articles, case reports, or book chapters

4. Administrative and leadership roles

   • Medical director for an inpatient unit or outpatient program
   • Program or associate program director for triple board or child psych fellowship
   • Committee work: GME, wellness, DEI, curriculum committees

Why Triple Board–Trained DOs Are Valued in Academia

You occupy a niche few others can fill:

• Bridge between pediatrics and psychiatry
  You understand both the medical and psychiatric sides of complex pediatric patients. Academic centers need faculty who can navigate both worlds, especially for consult-liaison and integrated care.

• Systems-thinker with holistic training
  Your osteopathic background prepares you to look at the child within family, school, and community systems. That aligns strongly with academic interest in social determinants of health and integrated, team-based care.

• Versatile teaching portfolio
  You can teach pediatricians about mental health, psychiatrists about medical complexity, and all learners about holistic care, communication, and interprofessional collaboration.

For these reasons, triple board DO graduates often receive multiple academic offers—sometimes even before graduation—especially in underserved regions or expanding children’s hospitals.

Pros of an Academic Medicine Career in Peds-Psych

1. Strong platform for impact

• You can influence future generations of pediatricians and psychiatrists to be more competent and comfortable with child mental health.
• Opportunities to build or expand integrated pediatric-psychiatry services (e.g., co-located clinics, collaborative care models).
• Ability to shape institutional policies around behavioral health, trauma-informed care, and family-centered care.

2. Protected time for growth and scholarship

Early-career faculty positions often provide:

• A percentage (e.g., 10–30%) of protected non-clinical time for:
  • Research or program development
  • Curricular design or quality improvement
  • Writing, grants, or presentations

For DO graduates who want to publish or become regional or national leaders, this is invaluable. Even modest scholarly productivity can distinguish you in a relatively small subspecialty field like triple board.

3. Collaborative environment

• Daily interaction with specialists in:
  • Neurology, developmental pediatrics, adolescent medicine
  • Psychology, social work, occupational/behavioral therapy
  • Ethics, public health, and education
• Built-in support for complex cases via multidisciplinary conferences and case discussions.

4. Reputation and career mobility

Academic titles (Instructor, Assistant Professor, etc.) and a track record of scholarship and teaching can:

• Open doors to national committee roles, guideline writing, or board positions
• Facilitate transitions later to leadership roles in large private systems or hybrid models
• Position you to influence policy and advocacy (e.g., school-based mental health, child welfare systems)

Challenges and Trade-Offs in Academic Practice

1. Compensation may be lower initially

Compared with high-volume private practice, academic salaries:

• Are often lower early in your career (sometimes by 10–30%)
• May be partially offset by:
  • Loan repayment programs (NIH, HRSA, state-based)
  • Excellent benefits and retirement matching
  • More predictable income and minimal business risk

2. Less control over schedule and clinical mix

• Clinic templates, inpatient coverage, and call schedules are usually determined by the department.
• You may be assigned to specific service lines (e.g., consult-liaison, inpatient child psych) that don’t fully align with your preferences at first.
• Change is possible, but often requires seniority or negotiations with division leadership.

3. Pressure to “do it all”

Academic roles may expect contributions in:

• Clinical care
• Teaching
• Research or QI
• Committees and institutional citizenship

Balancing these—especially in early years—can lead to burnout if boundaries and expectations are not clearly set.

4. Variable DO inclusiveness

While DO–MD equality in the osteopathic residency match and ACGME system has improved significantly, some academic environments still:

• Under-recognize osteopathic training and scholarship
• Have unconscious bias about DO credentials, especially outside pediatrics/psychiatry

That said, many children’s hospitals are enthusiastic about DO faculty, especially in holistic, family-systems-focused care areas. It’s crucial to assess culture during your interview process (see advice later).

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Private Practice in Peds-Psych: Models, Freedom, and Real-World Constraints

Private practice is not a monolith. For triple board–trained DOs, it can range from:

• Solo child & adolescent psychiatry practice
• Group child psychiatry or multi-specialty mental health clinic
• Integrated pediatric primary care/behavioral health settings
• Concierge or boutique models
• Part-time private pay practice combined with other roles

Your combined pediatrics and psychiatry training allows you to design particularly creative models (e.g., integrated developmental/behavioral clinic with medical and psychiatric management under one roof).

Typical Private Practice Models for Triple Board DOs

1. Traditional child & adolescent psychiatry practice

• 60–90 minute new evals; 20–45 minute follow-ups
• Focus on:
  • ADHD, anxiety, depression
  • Autism spectrum, disruptive behavior, trauma
  • Medication management with or without psychotherapy
• May see some young adults or family-based work.

2. Integrated behavioral pediatrics clinic

• You market yourself explicitly as both pediatrician and psychiatrist.
• Services include:
  • Medical and psychiatric evaluation of complex developmental/behavioral problems
  • Coordination with schools, therapists, and pediatricians
  • Short-term psychotherapy or parent coaching
• Potential to bill both medical and psychiatric codes, depending on structure and payor mix.

3. Niche specialty practice

• Focused clinical area, such as:
  • Pediatric OCD/anxiety
  • Eating disorders
  • High-risk perinatal/infant mental health
  • Neurodevelopmental disorders (ASD, ID)
• Often higher private-pay demand, especially in affluent regions.

Pros of Private Practice for a Peds-Psych DO Graduate

1. High degree of autonomy

• You decide:
  • Which age groups and diagnoses to focus on
  • Visit length, follow-up patterns, treatment modalities
  • Whether you do therapy, primarily med management, or a mix
• You can restrict your practice away from areas that drain you (e.g., limit high-acuity or forensic cases).

2. Income potential

• Especially with:
  • Private-pay models,
  • Efficient scheduling, and
  • Minimal no-show rates

you can out-earn many academic roles by a substantial margin.

• Group practices can provide economies of scale (shared overhead, billing, staff) and immediate referral streams.

3. Schedule flexibility

• Control over clinic days and times (e.g., 4-day workweek, only daytime hours, limited evening/weekend work).
• Ability to ramp up or down volume as your life changes (e.g., parenting, caregiving responsibilities, burnout mitigation).

4. Geographic flexibility

• You can choose locations:
  • Near family or preferred lifestyle regions
  • With high unmet need for child psychiatry (very common nationwide)
  • With favorable payor mix or telehealth regulations if offering virtual care

Challenges and Risks in Private Practice

1. Business and administrative responsibilities

Even in a group practice, someone must manage:

• Credentialing and insurance contracts
• Billing and collections
• Office lease, EHR, malpractice insurance
• HR for staff (front desk, billers, therapists, etc.)
• Compliance, privacy, and regulatory requirements (HIPAA, DEA, telehealth laws, etc.)

As a DO graduate, your medical training likely did not include robust business education. You’ll need to either:

• Learn on the job (with risk and time investment), or
• Partner with experienced administrators, or
• Join an established group where infrastructure already exists.

2. Professional isolation

• Less exposure to:
  • Multidisciplinary academic discussions
  • Residents and students (unless you arrange affiliations)
  • Daily peer consultation and informal teaching
• This can increase risk of clinical blind spots and burnout if you don’t deliberately build peer networks.

3. Complex case boundaries

As a triple board physician, you may attract:

• Highly complex children with medical–psychiatric interface problems, sometimes beyond what a solo outpatient setting can safely manage.
• You’ll need clear policies about:
  • Hospitalization thresholds
  • 24/7 coverage and crisis management
  • Coordination with pediatric hospitals and community agencies

4. Insurance and payor challenges

• Low reimbursement for mental health vs time spent.
• Prior authorization burdens for many psychotropic medications.
• Difficulty getting fairly paid for collateral work (school calls, coordination meetings).

Many child psychiatrists eventually move toward a mixed insurance/private-pay or full private-pay model to address these pressures—but this can limit access for underserved families and may conflict with your values or mission.

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Academic vs Private Practice: Comparing Key Domains

When you’re choosing a career path in medicine, side-by-side comparison can clarify your priorities. Below is a conceptual comparison tailored to a DO graduate in peds-psych/triple board.

1. Clinical Scope and Variety

Academic medicine:

• Broad mix: inpatient, consult-liaison, outpatient, special clinics.
• High exposure to rare, severe, and complex cases.
• Multidisciplinary, often includes trainees in nearly every clinical encounter.
• Less control initially over your exact mix; more structured service lines.

Private practice:

• Scope largely defined by you (with market forces and safety constraints).
• Typically more outpatient-focused and stable longitudinal relationships.
• Can narrow to selected conditions/populations.
• Limited inpatient/consult exposure unless you separately contract with hospitals.

2. Teaching and Mentorship

Academic:

• Formal expectation and infrastructure for teaching.
• You can be a primary educator for:
  • Triple board residents
  • Child psych fellows
  • Pediatric residents and med students (including DO students on rotation)
• Opportunity to become known as a regional/national expert teacher.

Private practice:

• Informal teaching of families and community providers.
• Some practices host students or residents through university affiliations, but this requires extra coordination.
• You can engage in teaching via:
  • Lectures to schools or community groups
  • CME talks for local pediatricians
  • Online courses or tele-education projects

If teaching and mentoring are central to your professional identity, academia has clearer pathways and reward structures.

3. Research, Scholarship, and Innovation

Academic:

• Built-in access to:
  • IRB, statisticians, research mentors
  • Grant offices, QI infrastructure
  • Internal funding and pilot grants
• Easier to conduct and publish studies, especially with existing patient populations and data systems.

Private practice:

• Possible but more challenging:
  • Smaller patient volume, limited data collection infrastructure.
  • IRB and regulatory hurdles if not affiliated with academic center.
  • Time constraints when you are also the main clinician and business owner.
• Many private practitioners instead:
  • Collaborate as community partners in academic research
  • Focus on practice-based QI and informal innovation

If a robust academic medicine career with research and publication is important to you, academia offers the more straightforward route.

4. Income, Security, and Lifestyle

Academic:

• Income: Moderate to high, generally stable; bonus structures may reward productivity or leadership roles.
• Security: Typically high job stability once established; robust benefits and retirement.
• Lifestyle:
  • Some call responsibilities, but often shared across a team.
  • Administrative and after-hours tasks (emails, charting, prep) can be significant.
  • Protected time for non-clinical work can support work–life balance if used intentionally.

Private practice:

• Income: Potentially higher ceiling, especially with efficient operations and private-pay models.
• Security:
  • Greater risk (business failures, local market changes, insurance contract shifts).
  • But demand for child psychiatry is so high that clinical job security is generally favorable, even if specific practice models change.
• Lifestyle:
  • More control over hours and workload.
  • Business-related stress can intrude on personal time.
  • Vacation coverage and time off must be proactively planned.

5. Identity, Values, and Long-Term Goals

Ask yourself:

• Do I see myself as a clinician-educator, clinician-researcher, or primarily a clinician-entrepreneur?
• How important is serving underserved populations and maintaining broad access to care?
• Do I want to eventually hold leadership roles in:
  • Hospital systems or medical schools?
  • Large group practices or multi-site clinics?
  • Community agencies, policy organizations, or advocacy groups?

Your answers will often point naturally toward:

• Academic tracks (clinician-educator or clinician-researcher)
• Private or hybrid tracks (clinician-entrepreneur, clinical innovator, or system-builder in community settings)

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Hybrid and Evolving Paths: You Don’t Have to Choose Forever

A crucial reality: your first job does not lock in your entire career trajectory. Many DO graduates in triple board or peds-psych careers move between academic and private settings—or create hybrid roles.

Common Hybrid Models

1. Academic + part-time private practice

   • 0.6–0.8 FTE at a children’s hospital/medical school
   • 0.2–0.4 FTE in a small private clinic or telehealth practice
   • Pros:
     • Diversified income streams
     • Maintain academic identity and teaching
     • Exercise autonomy and niche practice in private setting

2. Hospital-employed but non-academic

   • Large health system job with robust clinical infrastructure but minimal teaching/research expectation.
   • Often similar to academic patient mix, without academic titles and pressures.
   • May still allow affiliation for occasional teaching or adjunct appointments.

3. Private practice with academic affiliation

   • Primarily a private clinician but:
     • Supervise learners one day a week
     • Hold an adjunct faculty appointment
     • Participate in collaborative research or teaching programs

This can satisfy needs for intellectual stimulation and mentoring while maintaining the operational control of private practice.

Strategic Career Planning Over Time

For many DO graduates, a useful sequence might be:

• Years 0–5 (Early Career)
  • Start in academic medicine:
    • Build broad clinical expertise and comfort with complexity
    • Gain teaching and leadership experience
    • Establish reputation, network, and possible research portfolio
• Years 5–10 (Mid-Career Exploration)
  • Reassess values, lifestyle, and interests.
  • Consider:
    • Adding a small private practice
    • Negotiating changes in FTE and responsibilities
    • Exploring leadership or program-building roles
• Years 10+ (Mature Career)
  • Convert experiences into:
    • Senior academic leadership roles, or
    • Large-scale private or organizational practices, or
    • Consulting, telehealth networks, or policy advocacy

The key is to treat your career as a deliberate, flexible journey, not a one-time, irreversible decision.

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Practical Steps to Decide: From Reflection to Negotiation

1. Clarify Your Non-Negotiables and “Nice-to-Haves”

Write down your priorities across domains:

• Clinical:
  • Inpatient vs outpatient focus
  • Age range preferences
  • Comfort with high-acuity vs stable longitudinal care
• Teaching/Scholarship:
  • Must-have, would-like, or not important?
• Location:
  • Geographic constraints, spouse/partner’s job, family needs
• Lifestyle and Wellness:
  • Maximum acceptable weekly hours
  • Evening/weekend tolerance
  • Call expectations
• Financial:
  • Minimum acceptable salary
  • Loan repayment needs
  • Risk tolerance for variable income

Use this to evaluate positions against your personal matrix, not against what peers are doing.

2. Do Targeted, Honest Informational Interviews

Reach out to:

• Triple board or peds-psych DOs 2–10 years out of training in both academic and private practice.
• Ask specific questions:
  • “What does a typical week look like?”
  • “What surprised you about this setting?”
  • “What do you miss most from other paths?”
  • “What one thing would you change about your current job?”

Try to speak with people whose lives resemble the one you’re aiming for (family structure, location, clinical interests).

3. Scrutinize Job Offers Beyond Salary

For academic offers, ask about:

• Protected time for non-clinical work and how it’s monitored
• Concrete expectations for:
  • RVUs or clinical sessions per week
  • Teaching and committee work
  • Promotion criteria and timeline
• Support for DO faculty (mentorship, leadership opportunities, osteopathic recognition if any)

For private practice offers, ask about:

• Ownership structure and buy-in opportunities
• Billing and collections transparency
• Average new vs follow-up visit lengths
• Payor mix (commercial, Medicaid, private pay)
• Support for:
  • Credentialing
  • Malpractice
  • Office staff and EHR

4. Negotiate with Your Future Self in Mind

For a DO graduate in peds-psych, specific negotiation points might include:

• Academic roles:

  • A defined educator or integrated care track that leverages your triple board training
  • Commitment to start or join an integrated pediatric-psychiatry clinic
  • Formal mentorship in educational scholarship or QI
  • Early pathway to leadership (clinic director, training director)

• Private practice roles:

  • Flexibility to build a peds-psych niche (med-psych kids, developmental/behavioral focus)
  • Protected admin time for complex care coordination
  • Option to engage in part-time teaching or community outreach

Frame your requests around mutual benefits: how your unique peds-psych and DO background can advance their mission, attract referrals, and differentiate their program or practice.

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FAQs: Academic vs Private Practice for DO Peds-Psych Graduates

1. As a DO graduate, will I be at a disadvantage in academic medicine compared with MD peers?

In most modern pediatric and psychiatry departments, you should not be at a structural disadvantage. The ACGME merger and integrated osteopathic residency match system have normalized DO credentials, especially when you’ve completed a recognized triple board or peds-psych residency. That said, institutional cultures vary. Use interviews to assess:

• How many DO faculty are on staff and in leadership?
• How DO residents and students are integrated and supported?
• Whether your osteopathic perspective is seen as an asset or barely acknowledged.

Bring confidence in your training and skills; your combined expertise in pediatrics and psychiatry is often far more salient than degree letters.

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2. Can I start in academic medicine and move to private practice later (or vice versa)?

Yes, and many physicians do. Common patterns include:

• Early-career academic practice to build experience and reputation, then moving into:
  • Group private practice
  • Integrated hospital-employed but non-academic roles
• Private practice physicians later obtaining adjunct academic appointments or part-time teaching roles.

Keep your CV active with:

• Some teaching, local talks, or committees
• Occasional presentations or publications

This will help you stay mobile between sectors.

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3. Which setting is better if I’m considering a long-term leadership role in systems of care or policy?

Both can work, but they offer different pathways:

• Academic medicine career:

  • Easier access to roles in hospital leadership, training program direction, and research-driven policy work.
  • Stronger platform for national committee roles and guideline development.

• Private or hybrid practice:

  • Can lead to leadership of large clinical groups, telehealth networks, or community-based systems.
  • Positions you for policy work from a community practice perspective, sometimes with more operational agility.

If you’re drawn to high-level policy, large-scale system redesign, or national advocacy in pediatric behavioral health, academia is often the more direct launching pad—but combining it with real-world private practice experience can be highly advantageous.

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4. How do I know if I’m more suited to academic vs private practice right now?

Reflect honestly on:

• What energizes you most:
  • Direct patient care with autonomy and focus, OR
  • Teaching, mentoring, and building new programs—even if that means more meetings and committees.
• Your tolerance for business and administrative uncertainty vs institutional bureaucracy.
• Your immediate financial needs and loan burden vs your desire for protected time to grow as an educator or scholar.

If you’re uncertain, a well-structured academic position with supportive mentors can provide a strong foundation and keep many options open. You can always incorporate private practice later. Conversely, if you have a very clear vision for a niche, community-rooted peds-psych practice and are comfortable with entrepreneurial risk, starting in private or hybrid practice can be the right choice.

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Choosing between academic medicine and private practice as a DO triple board or peds-psych graduate is not about finding the “one right answer.” It’s about aligning your values, strengths, and goals with the right environment for this stage of your life—while keeping the door open to evolve as you and the field grow.