Medical business management

The realities of working in public vs private healthcare

Dr Machaba began her career in Thembisa Hospital, where she confronted long hours, limited resources and high patient demand.“In public health, you face patients who sometimes can’t afford basic needs. You need mental resilience, strong coping mechanisms and the ability to do a lot with very little,” she explains.

The transition to private medical practice was a dramatic shift. Patients were more educated about their health, resources were readily available and clinical decisions could be implemented immediately.

“In private care, I could apply my knowledge fully. If I needed a medication or a test, it was accessible within 24 hours. The patients ask questions, engage with their care. It’s a completely different environment from public hospitals.”

Her experience highlights how navigating these two worlds requires distinct skills: resourcefulness and resilience in public hospitals, versus operational planning, patient education and business acumen in private practice.

“Each system has its own survival mechanisms. Success in private practice is about blending clinical expertise with entrepreneurial mindset and adaptability.”

Building a strong multidisciplinary support system

Transitioning to private practice requires more than medical skill. Dr Machaba emphasises the importance of building a multidisciplinary support team (MDT), both professionally and personally.

“Your practice needs a team, from front-desk staff to accountants and practice managers. And your family must be part of that support system. Without that, private practice can strain relationships.”

Her own practice began by joining an existing group of paediatricians, which gave her practical mentorship in clinical and business operations before going solo.

“Mentorship saved me years of trial and error. It’s invaluable for navigating both patient care and the business side.”

Dr Machaba candidly shares her challenges, including having to restart her practice alone after structural issues in her previous clinic.

Steven Macarounas underscores the lesson:

“Many doctors underestimate the responsibility of being a business owner. Understanding finances, operations and systems early minimises mistakes and sets you up for sustainable success.”

Gareth Harvey adds that working in an existing practice first helps mitigate risk and provides a roadmap for independent success.

Financial planning for medical professionals

Dr Machaba stresses that clinical success alone isn’t enough; financial planning is essential.

“Know your costs, your cash flow and your investment needs. Lean on accountants and financial advisors but also understand the basics yourself. Without a plan, even the best clinicians can struggle to sustain their practice.”

She shares how setting up her finances early helped her make informed decisions and invest in growth.

“Having a clear financial roadmap gave me confidence to expand, hire the right people and focus on patient care without constant stress.”

Gareth Harvey highlights the broader perspective:

“Planning financially isn’t just about today, it’s about freedom tomorrow. Proper planning lets you scale, take time off and protect both your practice and your family’s future.”

Key takeaways for medical professionals

• Transitioning from public to private practice requires mindset shifts, financial literacy and operational planning
• A strong support network (family, mentors and multidisciplinary team) is critical to success
• Scaling your practice through education, technology and delegation improves both impact and work-life balance
• Purpose-driven work fuels long-term satisfaction and resilience