So I'm not finding exactly what I want job wise. Understandably, I may never find what I want. I've got a target city in mind and all I have so far is a super lowball offer. The other people in town either won't respond to me or have told me they're not hiring.
My question is what does it take to go solo? And is it advisable in this current political climate? .
I am in my last year of residency and also have gone through looking in a saturated area, then decided on starting up a solo practice in a different area in the same region that has need. I thought I would post some of what I have researched, obviously I haven't had actual business experience, so I would welcome some comments from the more experienced private practice guys. From what I have found: Your available options are pretty much night and day depending on the need in the area. Of course location is key to quality of life. I really like the area I will be going to, but it is not a big city like I was originally considering.
1) offers to join practices - in the current medical climate, it seems like established practices are more leary to take new people on, and certainly to provide substantial income guaruntees. $140K in a saturated area may not be that bad for year 1. It is almost certainly better than you could do in solo practice without help from a hospital. Having a income guaruntee of $140K may be very generous, assuming that is what you are taking home, they are covering your overhead also, and all the support is coming directly out of the pocket(s) of the current partner(s). The reason a practice would do this is so they can eventually have you as a partner to decrease the amount of overhead they pay, and also you would be contributing referrals and support to ancillary services like audiology, hearing aids and allergy that usually turn a profit.
2) hospital support - I wish I did more looking in to this earlier in my job search. You can get income guaruntees from hospitals if there is a need in the area. That can come in the form of helping someone start a solo practice, or support tojoin an established practice. I suspect many of the advertised income guaruntees to join group practices in higher need areas may be involving hospital support. You are not going to be able to get this in saturated areas, for example, non-profit hospitals have to show this type of support is reasonable, relative to need in the area, in order to keep their non-profit status. My advice to anyone exploring options in different areas, is to not only contact practices in the area, but contact the hospital administrators in charge of hiring/recruitment (usually a VP of medical staff) at all of the major hospitals. This will give you an idea of what type of support you can get, and what the need in the area is. A private practice may not be agressively recuiting, but indifferent to taking on someone new, and leary of paying a salary guaruntee. However, if you bring to them support from a hospital they might be thrilled to have someone to help cover overhead.
3) going out on your own - you could obviously do this with or without hospital support in any area regardless of need. In a saturated area this is going to be much more difficult for multiple reasons, but still theoretically possible, I suppose.
a) your balance sheet is going to be much less favorable in a saturated area
- higher rent
- higher malpractice
- lower insurance reimbursement
- slower establishment of referral base
- more competition for good payor mix / lucrative procedures
b) due to (a), getting a medical business loan is going to be harder. These can be pretty easy to get in a high need area, I didn't even look at formulating a business plan and seeking a loan in a saturated environment. It would be interesting if someone has done this.
I found some information from an accoutant from the National Society of Certified Healthcare Business Consultants 2011 Otolaryngolog survery: (all figures per full time employed ENT)
average collections + other income = $935,813
average overhead = $600.393
net income = $335,420
These are average numbers, including solo and multiple physician practices with more efficiency regarding overhead. Imagine a solo practice business plan in a city where rent/taxes/payroll are significantly higher and reimbursement is lower.
On top of that you mentioned that you like doing everything. The ENT docs I meeet in saturated areas are fighting tooth and nail for cases initially, and seem to settle in to doing largely tubes/tonsils. That was definately a big factor in moving me away from a big city, b/c I like doing more complicated/challenging cases. I also want to get my foot in the door doing some baloon sinuplasty and cosmetics. You always have to cater to your referring physicians, but I like the idea of making that easier by moving to an area where ENTs are less available.
How does one start does down this road? I know I need a state medical license, NPI number, and hospital privileges. How do I get hooked up with insurance providers so I can start getting paid? Do I need to secure a loan to buy used equipment, pay for rent, hire an MA, advertise, etc? Is that a hard thing to get? .
- I found a detailed checklist from my state medical society outlining in detail the things you need to do 12, 9, 6, 3 mos prior to starting to practice. It is probably different state to state, but I would seek something like that out. First thing you need a state liscence, before you can apply for insurance coverage and privledges. If you are going solo you need to establish a business entity and tax ID#, as well as a buisness plan prior to seeking loans to support your business plan. Finding an accounting firm that is experienced with medical practice managment would be a great resource.
How do you find a place to work? Do you rent space out from someone when they don't use it? I can't imagine an ENT would want competition in town using their office..
see above. If you want to do solo, you would have to either buy an existing practice, or buy or rent office space. Options are pretty vast and variable you can alway make improvements to leased office space to make it in to a medical office. You would have to factor that in to a business plan.
What do you guys think? I just hate settling and feeling like my future is based on someone else's whim..
Again, it totally depends on your location of practice. I think is is smart to consider a solo practice option, if only to put in perspective what you are gaining from joining a practice.
