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Careers in public vs private health: an overview of the pros and cons

GradAustralia

Starting your career in the health sector? Find out the reasons why you might choose to focus on either the public or private health industries.

The Australian healthcare system is structured such that, broadly speaking, your prospective employers will fall into one of two categories: public and private. Public health institutions are funded by the state, territory, or Federal government, and managed by state and territory bodies, such as the NSW Ministry of Health. By contrast, private health institutions are independently owned and operated but regulated and licensed by the government.

It’s important to note that most healthcare providers begin their careers in the public sector. For example, while studying, student doctors and nurses usually complete mandatory placements in public hospitals. As graduates with a provisional registration, they must undertake an internship that, with few exceptions, also requires them to work within public institutions. This article, then, is designed to help you consider the long-term nature of your career. Eventually, you will be able to decide whether you’d like to pursue employment in public institutions or private ones—to help you consider these options, we’ve brought together some of the pros and cons of careers in both sectors.

Public health

Pros

Excellent job security

One of the most frequently cited advantages of obtaining any public sector position is that such roles offer enviable job security. As a general rule, this holds true: job loss rates are lower in the public sector than in the private sector.1 This is partially attributed to the public health system’s broader range of support resources for employees who experience professional setbacks or performance issues. As a caveat, however, it should also be noted that the public health system is increasingly dependent on contracted workers who tend to lack the job security of employees with full-time positions.

Opportunities to become involved in policy work

As mentioned above, while private healthcare providers are independently owned and operated, they must still abide by regulations generated within the public sector. For example, the Federal Government is responsible for drafting and enforcing broad national policies, while state, territory, and local governments assume responsibility for managing hospitals and, via policy initiatives, ensure both the effectiveness and efficiency of the public health systems within their jurisdictions. By participating in such initiatives within the public health system, healthcare workers have an opportunity to affect large-scale policy changes that improve outcomes for whole patient populations.   

You can address public health issues head on

It stands to reason that public health issues are, for the most part, addressed by the public health system. The Australian Institute of Health and Welfare has identified nine national health priority areas (NHPA): cancer control, cardiovascular health, injury prevention and control, mental health, diabetes mellitus, asthma, arthritis and musculoskeletal conditions, obesity and dementia. Other areas of concern include the continuing disparity between health outcomes for indigenous and non-indigenous Australians, the accessibility of health services in rural and regional parts of Australia, and complex issues of funding and financial sustainability.

By working within the public sector, you’ll be able to interact directly with people who need health services rather than treating only those who can afford them. You can also choose to participate in public health programs (including initiatives designed to address the NHPAs), or take your skills to underserved areas of Australia, such as isolated communities. This gives you a fulfilling and socially constructive opportunity to improve health outcomes in the populations that most need support.

Cons

Your career progression can be slower

Whether you’re a physical therapist, a pharmacist, a nurse, or a doctor, you may find that career progressions in the public sector follows a predetermined path and pace. For example, the career progression of a medicine graduate is relatively fixed, with on-the-job training (i.e. internships and residencies) leading, after set periods, to predictable phases of additional education (for example, in order to qualify as a specialist). Generally, such progressions cannot be expedited—you won’t be able to become, say, an anaesthetist by rushing through the obligatory training.

Of course, the same holds true for specialisations within the private sector. However, independent employers have more freedom when it comes to titles, salaries, benefits, and other careers perks that, in the public system, are standardized and, for the most part, non-negotiable. For this reason, it can often seem that employees in the private sector progress through their careers at an accelerated rate.  

Infrastructure, staff, and resources can be strained

The management of the public health sector is a politically charged issue, with Federal and state governments held accountable for the quality, accessibility, and overall performance of public hospitals and other medical services. Over recent years, the expansion of public health infrastructure, coupled with challenges in staffing and funding, have created an environment that some experts say is rife with inefficiencies. For example, you may have read about the national shortage of in-patient hospital beds, the demand for more dedicated aged care facilities, or the rising rates of hospital-acquired diagnoses (such as staphylococcus infections). Certainly, working within the public health sector can mean accepting that you won’t always have access to the same resources as your counterparts in private hospitals and businesses, which, in turn, may generate or exacerbate occupational stress.

Private health

Pros

Reduced caseloads

The question of caseloads—the number of patients a healthcare worker will be exposed to during a given period—is complicated. Traditionally, it has been the case that private health employees enjoy lower caseloads, because their control over admission rates allows them to focus more on each patient, avoiding the endemic overwork that tends to occur in the public health sector.

However, recent initiatives have sought to correct the issue of unfeasible caseloads within the public health sector. For example, advocacy by the NSW Nurses and Midwives’ Association led to the enforcement, in metropolitan hospitals, of nurse-to-patient ratios designed to improve patient care while preventing individual nurses from being overwhelmed.2 Hopefully, similar campaigns will improve outcomes for patients and healthcare workers more broadly in the public sector. As it stands, administrators in the private sector remain in a better position to maintain feasible patient-to-employee ratios.

Greater involvement in business decisions

As mentioned above, though private hospitals and medical facilities are regulated by state and federal government bodies, they are independently managed and operated. As a result, critical business decisions are not made or approved by public administrators. Instead, like all private businesses, private health services providers retain a degree of autonomy when it comes to how they are run. The ability to participate in or influence business decisions promises employees a greater degree of control over their work environments—although, as we’ll see in the next point, private health employers already tend to offer…

Superior work environments

The quality of workplace environments in the private health sector is a key source of their appeal to both patients and prospective employees. It’s easy to understand why private health sector workplaces are so often more appealing in terms of design, comfort, functionality, and newness. Public health institutions are driven to cut costs in a bid to free up funds that can be used to make medical services accessible to as many people as possible. By contrast, private health organisations are driven to generate profit—hence, investment in consumer-friendly environs makes sense on a business level. Little wonder then that, in the 2014-2015 financial year, private hospitals spent a higher proportion of their budget on upgrades and maintenance than public hospitals.3

Cons

You’ll need to generate business

The flow of patients into the public health sector is, to an extent, non-competitive—patients who call ambulances, enter emergency wards, or seek urgent secondary care are usually taken to public hospitals by default. Indeed, private health providers have raised concerns about the frequency with which private patients (those with private health insurance) avail themselves of public services. One reason for their misgivings, of course, is that private health providers, like all private organisations, must compete with one another for business (which, in their case, correlates roughly to patient numbers). Herein lies a challenge for private health employees—they must work to generate business, whereas their public health counterparts are assured a regular flow of inpatients.

Your income is more likely to fluctuate

As noted above, public health salaries are determined by state award levels and, as such, relatively stable. By contrast, remuneration within private settings is determined by owners and operators, whose decisions are more likely to be guided by revenue projections, staffing requirements, and available funds. In smaller practices, where employees receive equity payouts instead of salaries, this can lead to income fluctuations of the kind that are seldom seen in public institutions.  

To find graduate opportunities in the health sector, visit GradAustralia’s job search directory.