When I finished my residency almost 20 years ago, everyone in medicine warned that HMOs would be the end of private practice medicine. Twenty years ago, like today, government reform of healthcare loomed large--but legislation still did not eradicate the solo or small group practitioner. Everyone preached, "the solo practitioner will be extinct in five years," or "you must be insane to go into private practice."
I'm glad I did not listen.
It is true that the proportion of physicians in solo or two-physician practices fell from 40 percent in 1996 to 32 percent in 2004; but a trend doesn't necessarily dictate success. In fact, as fewer small groups and private practitioners abound, you will find more opportunity to differentiate yourself and your practice from others.
It is also true there are a few specialties, such as radiology or anesthesiology, that have become entirely dependent upon hospital contracts for employment. But most other specialties, including family practice, internal medicine, cardiology, rheumatology, infectious disease, geriatrics, gastroenterology, dermatology and many, many more are all ripe for solo or small physician group practices.
We are in the age of big corporations, but there will always be room for the little guy. There is room for better customer service, intimate one-on-one care, and the "non factory" or "non mill" practice. Why do you think concierge medicine is appealing (though not affordable) to the masses? People want customer service. They want personal care. They are tired of being a number.
The private practitioner, no matter the political rhetoric, will always survive and thrive. We are the essence of small business in America. We are emblematic of the spirit of capitalism. And although corporate America wants to shut you down, acquire you, convert you, or push you into a large group, as long as capitalism survives in America, you will not only survive, but you will succeed.
Initially, it may be intimidating, but persevere. Anyone, even without any formal business education or experience, can start his or her own practice. The key to success is preparation.
You must attack private practice like you would prepare for an exam or a clinical or surgical rotation. Would you perform a surgery without first reading everything you could about the procedure, the vessels, nerves, danger zones and potential mistakes you could make in the operating room? No. You should not enter private practice without the same preparation. You must understand the bottom line, financials, profit and loss sheets, capitalization, lines of credit, legal issues, licenses and how to negotiate with insurance companies. It sounds hard but it's not.
What are the benefits of creating your own small private practice today?
In most situations, you will make more money than you would in a larger group practice. The reason is simple. A group practice must make a percentage of the revenue you generate. The amount that it makes from your work will be the extra amount you would keep for yourself if you went into solo practice. By staying independent, you will have freedom, individual creativity and lifestyle benefits. You will create your own rules and your own hours. You will answer to no one.
And even the issue of call and hospital coverage, which traditionally had been very burdensome for private practice physicians, today is almost completely resolved by the use of hospitalists and other soloists providing inpatient care. To sum up, going it on your own is exciting, liberating and rewarding.
Don't be afraid. Don't be intimidated. Be prepared.
Steven M. Hacker, MD, is a board certified dermatologist and author of the book, The Medical Entrepreneur: Pearls, Pitfalls and Practical Business Advice for Doctors. Learn more at TheMedicalEntrepreneur.com. This article contains some excerpts from that book.