Colleagues want to know how he did it
Clinton Sheets, MD, an ophthalmologist in Hudson and Clearwater, Fla., went solo in 2019 after being in a group practice for 11 years. Since he opened up, “I get phone calls from colleagues all the time, asking me about how I did it,” he said. “At least two of them followed in my footsteps.
“I tell them it’s very doable,” he said. “If you have the motivation, you can do it. Depending on your competence, you can outsource as much or as little as you want. Some management companies can do almost all of the nonclinical work for you.
“Smaller practices can streamline processes because they have a flatter organizational structure and have fewer issues with administrative bloat than larger organizations,” he said.
“Technology hinders and helps a private practice,” he said. On the one hand, he had to buy a lot of expensive equipment that otherwise would be shared by a group of doctors. On the other hand, using the cloud makes it possible to easily store practice management software and the electronic health record.
He’s opening a private practice while staying employed
In December, Dev Basu, MD, a hospitalist in Baltimore, plans to start his own private practice, seeing patients in skilled nursing homes, while still working as a nocturnist in a large health care system.
He said his employer has been supportive of his plans. “My work will not directly compete with them and it will benefit them by serving patients discharged from their hospitals,” said Dr. Basu, 38. He added, however, that he will be allowed to work only at certain facilities, and these will be subject to annual review.
“The financial risk of the new practice is low, because I haven’t had to invest much,” he said. “I won’t have a staff or an office.” He plans to maintain his full schedule as an employee, working 12 nights a month, because it will give him a great deal of time to do the new work.
“I also have no particular interest in running a business,” he said. “I come from a family of doctors, professors, and teachers who never ran a business. But I’m willing to learn so that I can practice medicine the way I want to.
“The ability to set my own schedule and deal with patients in the way I think is best is very important to me,” he said.
Private practitioners don’t have to face ‘moral distress’
One thing private practitioners typically don’t have to contend with is “moral distress,” which occurs when you have to follow institutional concerns on how much time you can spend with a patient or on the need to keep referrals in-house, according to Marie T. Brown, MD.
Dr. Brown is an internist who ran a small private practice in Oak Park, Ill., and is now the physician lead for the American Medical Association’s STEPS Forward program, which provides strategies on how to improve a medical practice.
“In my private practice, I could control the time I spent with each patient,” she said. “I also had control over my schedule. If I didn’t have the time, I just took a lower income, but that was okay.”
Dr. Brown said it is a myth that employment offers a better work-life balance. “Young physicians who take employment for this reason may find that they’re not allowed to drop off and pick up their children from school at a certain time. But you can do that in a private practice.”
She said it’s not that hard to run a practice. “Young physicians don’t think they could run a practice because they don’t have any business skills,” she said. “Yes, you do need some management skills, and you have to devote time to management. But you don’t need to have special expertise. You can outsource much of the work.”
A growing trend?
David J. Zetter, a consultant in Mechanicsburg, Pa., who helps doctors set up private practices, sees more interest in this in the past 5 years. “The overwhelming trend used to be private practices being bought up by hospitals and other entities,” he said. “Now we’re seeing the pendulum swing in the opposite direction.
“Generally, these doctors are fed up with being employed at a large organization,” he added. “Recently I got a call from a doctor who had never thought about running his own business, but he’s had it with being an employed physician.”
Switching to private practice is scary for a lot of them, but the alternative is worse. “A podiatrist I’m working with tells me she is scared to death about setting up a private practice, but she’s doing it because she doesn’t want to be employed anymore,” Mr. Zetter said.
A version of this article first appeared on Medscape.com.