Thoughts on private practice (solo)

[s2km]

I wanted to get thoughts and opinions in my situation regarding possibly starting a private practice.  Some background info: I'm in a surgical sub-specialty in a geographical area that could probably sustain a few more in my field.  All of the private practitioners in the area are over 55 and looking to taper down. I'm working with one of those practioners now and the schedule is full.   Originally the plan was to kind of take over/buy out after he decides to get out, but going through negotiations recently, it became clear that they just want to treat me as a cash cow.  I'm weighing options now and am considering starting my own practice after saving up a few years.

I know historically, that the percentage of private practices has been consistently declining - especially given how the ACA is now with the advent of ACO's and moving from fee for service to value based, etc.   Right now, it's still kind of up in the air how this will play out in terms of actual pay and how insurances will treat private practices vs hospitals, and that is where my concern lies.  I believe I have a good sense of how to actually run a private practice. I am entrepreneurial and would embrace the challenge of making it a success given that it's my own.  If I start up in the next few years, I feel I could carve out an area given everyone else is on their way out.  I've already established somewhat of a base already.  I could provide supplemental income by taking call at hospitals - i'm already covering 2 and getting compensated.

I'm just unsure if the healthcare landscape would support private practices in the future.  Would it be too much of a risk to start up given some of those favorable factors, or is the state of healthcare in the future to the point where private practice just won't survive no matter what?  Would others in my position open up a new private practice if they had the means?

Thanks!

 

[Zaphod]

There will always be space for productive and intelligently run practices in the future. In fact the pendulum and attitude has probably swung so far in the opposite direction that you may enjoy the tail winds of decreased overall competition and finding a group of pts that want that style compared to the alternative. Some of the loudest complaining practices of yesteryear were probably never run well because the money was good enough it didnt require as much work and the general attitude/naivete us doctors have business wise.

Do good work and run a lean shop, stay on top of it and you'll likely be fine. Lots of new headaches, but thats somewhat unavoidable.

[tex]

Seems like you have a good handle on your local market. This has nothing to do with your situation, but right now striking out on my own or even joining a small independent group with the goal to become partner seems like a pretty dumb move for neonatology in my geographic area. The large national corporations and one of the non-profit hospitals are rapidly expanding and have a huge market share, making job security a real issue.

[Rando]

I've been a solo FP for about 15 years now and it was definitely the right decision for me.  Whether it's the right decision for you depends on too many factors to address in one post.

 

You are right that things are unsettled right now in the healthcare landscape.  Without turning this into a ****************************** session there are elements in the ACA and MACRA that make it harder for solo physicians and small groups to compete against large groups and hospitals.  CMS just decided to shelve Meaningful Use which is great news, but it's going to be replaced by something else as it looks like the government is committed to collecting practice data and improving medical care.  Part of going solo these days is to keep track of government programs and decide if and how you're going to satisfy them.  The exception is if you're not going to accept Medicare then it becomes a moot point.

 

Best of luck to you whatever you decide!

[Jackmomma]

Hi there I just started a solo inpt type PM and R practice about 6 months ago. Prior to that I'd always been mostly an employed doc. So I've seen both sides. I think its do-able but you need to consider a few things.

It took me about 4 months before I saw a single dollar. Those 4 months were not fun. I am a good saver and had a lot of cash to fall back on but its just not fun sending in bills, and just waiting and waiting till you get your claims processed as a new practice.

Second, I'm still waiting to get on all the insurance plans. Since I don't do clinic its not as much of a dealbreaker for me as at least inpatient my rehab hospital knows which ones I'm not in network for and tries to give me more or less what I'm in network for. What I'm not in network for my billing company works with and I'm doign ok so far.

But you need to consider that there are quite a few insurance companies I've been trying to work with but they are flat out saying .. we're full on doctors etc. I think its BS but that's the world we live in now. That also takes months to get in network.

Then as a specialist you need tot hink about rent, and most importantly who you have to be your assistant, pick up calls, get co pays etc. I assume you aren't going do that as a surgeon. But I've known some docs who do it.

I think there will always be a place for solo docs. In fact I think as more docs get scared of going solo there are going to be better opportunities for those that hang their own shingle. I hope I'm one of them. You are right you need to pick your spots carefully. Sounds like you may have a good spot.

Keep us updated.

[Hatton]

I have run a solo OB/GYN practice for 20+ years.  The group of 4 that I was in imploded.  I never really planned on a solo practice but it happened.  I was one of the first female OBs in my area so I never needed to advertise.  I am now doing just gyn 3 days a week.  I am able to do this because I keep my overhead very low.  I have looked at several different docs numbers to see if it made sense to share space or merge.  I have always found people are paying too much rent and have too many employees.  My overhead is always lower.  It is much easier to keep your headcount low than to be faced with having to fire people.  Always remember that the nicer the building the more rent you pay and less money you make. I constantly evaluate my expenses.