Resources on the Business of Private Practice

[ophtho838]

Anyone have any good resources (books, blogs, websites, etc) on the business of private practice and the considerations/problems that private practice docs encounter? As someone struggling with decision between private practice vs academics, it would be nice to have all the info about the realities of private practice. Thanks in advance.

Edit: sorry just realized there was another recent thread with an excellent blog about solo practice. I'm looking for info about large multispecialty (or mono-specialty) practices as well.

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[schistosomiasis]

Location: most important. Will you be happy living here, is there room for growth or a saturated area?
Personality match: is this the type of practice that you are expected to see 50 patients a day with two weeks of vacation per year or only 15-20 with five weeks of vacation and Friday afternoons off? What are the other docs like? Do they order a lot of tests, routinely do surgery on 20/25 patients with minimal complaints, and churn patients just to bill insurance and make a lot of money? Or is it a concierge type practice?
Efficiency of practice: sound billing practices, with low accounts receivable? Collect patient responsibilities at time of service? Overstaffed with disgruntled employees that sit around, who owners aren't willing to get rid of due to loyalty? What's the practice overhead?
Decision making: equipment- everything you need or is owner willing to buy? Will your input be taken into account for hiring, firing employees, or expanding practice, etc? I know folks who made $500,000 a year but left due to lack of autonomy...
Divison of patients: where will your patients come from? Associate that left or build your own? Will you be in "competition" with others in practice or owner for patients and cases? Will you be seeing all the postops and taking call?
Reimbursement to practice: is the practice in a lot of capacitated plans (more in our blog), or plans with low reimbursement, that the owner wants to dump on you?
Your salary and earnings potential: are you being paid fairly? Is there a chance of a buy in? Is the buy in fair? Heck, if you pay me $2 million you can have my practice tomorrow...
Restrictive covenant: if the job isn't forever can you at least stay in the area?
Why did the other associates leave? Find out who they are and do digging no matter what.

Academics: I have the utmost respect for those who go this route. Lower pay, less autonomy and freedom to schedule. Dean's and chairman's tax on your earnings. Sometimes chairman can be difficult personality. Politics with other docs. But, you get to see challenging cases, teach residents, and learn from rest of faculty. Might be a good job to get feet wet. Know some folks who go part academics while opening their solo practice (either at university or VA hospital) then transition out in a few years when get busier in their own clinic.

Here are a few links:
Ho Sun didn't like anything he saw so opened up on his own: Evolution
I worked at two jobs before I went solo: Why I Went Solo; My Story
Here are the steps to go solo: Steps To Start a Medical Practice

And thanks for the kind words about our blog

 

[schistosomiasis]

For anyone who is interested the AAO has a course for young ophthalmologists on Monday November 13 at our meeting in New Orleans, welcome to the real world. While we’re not presenting, someone from AAO told us to be there so we’ll hang around to answer questions afterwards.

I’ll also be at a round table discussion for folks who already have solo practices on Saturday, and we’ll both be on the exhibit floor Sunday 11-1. Happy to speak with anyone about solo practice!

Here are the times and locations:

New Orleans AAO November 2017

 

[schistosomiasis]

A few more pertinent posts we just put up.

Many of you will join a group and eventually buy in, or purchase a practice and go solo. Here’s a post about practice valuations:

Practice valuations

And here’s another post about starting your own practice from scratch vs buying an existing one. The questions to ask when buying someone else’s practices are discussed. I suppose the same questions should be asked if you’re joining a bigger group.

Should I buy a practice or start my own from scratch?

 

[schistosomiasis]

Here’s another post about the reality of working in a large busy mega private practice:

Why a $300,000 junior associate salary may not be as good as it seems

 

[percyeye]

Thanks for putting these together. Most of the time articles on private practice are very vague because people are afraid to post real numbers but I appreciate seeing actual numbers on practice finance. Keep it up!

 

[dantt]

Great post regarding working in a mega private practice as there is little description out there about what is typical. I am just starting out in such a practice myself but I will offer an alternate opinion.

Neither I nor most of the associates and partners have to worry about running the "business" as we have a strong executive team figuring that stuff out. We focus on taking care of our patients and spend most of our time doing "doctor" stuff. I see my patients and talk to my patients while the techs do all the work-up and scribe. The techs are excellent as they are very well compensated and we are able to offer excellent benefits being a large group. Yes, the owners make a ton of money off the associates but the associates are very well compensated as well with an excellent incentive structure. One thing that was mentioned only briefly on the solo practice blog, yes, partnership is offered after 2-3 years and suddenly you become one of those owners making tons of money (while still focusing on patient care and doing what you want).

One other thing I forgot. When you're out in solo practice in a "desirable" high cost of living area, your surgical volume is going to be very low and your surgical skills may deteriorate. I am doing more volume right now than I ever did in training and I keep getting better at surgery every single day.

 

[schistosomiasis]

All excellent points made by Dan. We both have selection bias- I am on a listserv with 130 solo practitioners who couldn’t imagine joining a group, and he is in a group that seems to be run well with happy partners. To be fair many ophthalmologists work in a group and are extremely happy with their situation.

But let me counter some points- as a solo doc you have the freedom to hire as many or as few techs as you want! Some colleagues in our google group have the same setup with support. The emloyees I have hired are way better than the ones in my group, because I was careful about hiring them! And if you decide you need a tech or scribe you don’t have to run it by anyone or get an administrator to approve it! But you’re the one paying for it, so you live with the consequences of your decisions. In a group, depending on how income is divided partners might be incentivized to get as much support for themselves at the expense of the group- increasing overhead.

Here’s a post I just put up about potential pitfalls in a group: Income division and potential problems in a group practice

It seems like you’re really savvy about what a fair overhead and owner profit is, as well as what a fair buy in should be (Practice valuations). The purpose of my posts is that most doctors DON’T know these numbers (personally, I didn’t, even when I was starting up, only about six months in my solo pracice did I figure it out), and I have seen plenty of colleagues get taken advantage of due to their lack of knowledge, which is very unfortunate.

Dan’s group might be fair and equitable, but unfortunately I have heard and seen too many cases that aren’t. And my Why a $300,000 junior associate salary may not be as good as it seems post is not theoretical but rather a situation similar to what I was in myself, it makes my blood boil every time I think about it. Just warning everyone!

Finally, we know of many docs in our group who did more surgery the first or second year as a solo doc than when they were in a group- because when solo the owner in a group wasn’t taking cases away from them, or shifting surgery consults away from their schedule. Indeed, in my first year solo I did more cases than my first year out of training at my government job. There are many folks in groups in both urban and rural areas with low surgical volume but YMMV.

 

[schistosomiasis]

Our friends over at ophthoquestions just published this great anonymous post about what it’s like to work for Kaiser. Having worked for the government and then a similar organization myself I can assure you the information appears accurate:

Why I Left Kaiser (and Why You Might Want To) - OphthoQuestions

They also recently published an article that I wrote about what to do with your first $50,000:

What You Should Do With Your First $50,000 - OphthoQuestions