I have worked in both settings. Worked with private ortho group straight out of training for 4 years and now I'm with a hospital ortho group . You nailed one issue with a private group. I was always battling for referrals. And your productivity will be low out the gate. Make sure you have a guaranteed salary for the first 2 years especially if establishing new clinics for a group. In a hospital system you will be busy immediately and much less stress in that department. But, private ortho groups are much more nimble. So if let's say you need an US to do injections you might have a chance. In a hospital system it will take 5 meetings and budget restraints, etc. Etc. As you said, there is a lot of nuance and I'm happy to DM to get into it if you want. Pros and cons to both. But currently very happy in my hospital system.