Starting solo or group practice, worth it?

[userofthecentury]

First few years after residency in IM, working full time as a nocturnist, decent pay $260k+, should I be thinking about going on my own, starting a clinic or practice..worth it long term in maximizing the $$ income potential? Are there any resources that help provide perspective with details on the business side of things?

Pretty sure others here more experienced would have some experience, of their own or observations/opinions on the income potential of solo practice (or maybe a few docs - group practice).. or with all the consolidations and bigger groups, that ship has sailed?

TL;DR: Should someone making decent money at a job as a hospitalist think of starting a clinic to make more money and a more stable financial future etc? What're the good, bad and ugly of going the self employment route?

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[rokshana]

First few years after residency in IM, working full time as a nocturnist, decent pay $260k+, should I be thinking about going on my own, starting a clinic or practice..worth it long term in maximizing the $$ income potential? Are there any resources that help provide perspective with details on the business side of things?

Pretty sure others here more experienced would have some experience, of their own or observations/opinions on the income potential of solo practice (or maybe a few docs - group practice).. or with all the consolidations and bigger groups, that ship has sailed?

TL;DR: Should someone making decent money at a job as a hospitalist think of starting a clinic to make more money and a more stable financial future etc? What're the good, bad and ugly of going the self employment route?

You remember outpt medicine?

 

[chessknt]

First few years after residency in IM, working full time as a nocturnist, decent pay $260k+, should I be thinking about going on my own, starting a clinic or practice..worth it long term in maximizing the $$ income potential? Are there any resources that help provide perspective with details on the business side of things?

Pretty sure others here more experienced would have some experience, of their own or observations/opinions on the income potential of solo practice (or maybe a few docs - group practice).. or with all the consolidations and bigger groups, that ship has sailed?

TL;DR: Should someone making decent money at a job as a hospitalist think of starting a clinic to make more money and a more stable financial future etc? What're the good, bad and ugly of going the self employment route?

The fact that you know absolutely nothing should be a hard stop. It used to be pretty straightforward but the barriers are quite significant now. This is by design to force us in to employment--you can try to swim against the stream and a few might make it but the majority will lose a lot of time and money only to end up back under corporate ownership. best bet is to find an established practice that is still privately owned and get on a partnership track.

 

[IMGASMD]

There is someone who started his own practice that regularly updates here. It takes a lot of capital, time and gusto to make it work.

I for one am too chicken and risk adverse to do something like that. During my years, met a few IM who had their own offices, then folded to join the hospitalist teams. But also a few started their own practices, groups who are making a killing now too.

Good luck.

 

[InvestingDoc]

First few years after residency in IM, working full time as a nocturnist, decent pay $260k+, should I be thinking about going on my own, starting a clinic or practice..worth it long term in maximizing the $$ income potential? Are there any resources that help provide perspective with details on the business side of things?

Pretty sure others here more experienced would have some experience, of their own or observations/opinions on the income potential of solo practice (or maybe a few docs - group practice).. or with all the consolidations and bigger groups, that ship has sailed?

TL;DR: Should someone making decent money at a job as a hospitalist think of starting a clinic to make more money and a more stable financial future etc? What're the good, bad and ugly of going the self employment route?

First question. Do you like outpatient medicine?

If the answer is no, then you are going to have a very bad time.


Starting up your own practice is "worth" it if it is what you want to do. You work for yourself, you set the rules, you are in control of your future.

The downsides....its a ton of work along with the uncertainty that comes with running a business. The other downside is that you not only have to practice medicine but run a business.

I love getting to know people long term. I love running a business. It works for me but does not work for most doctors.

Running my own practice and growing it has been exciting and so challenging at the same time.

So yeah, if you like outpatient medicine, love the long term relationships with your patients, and don't mind running a business working full time as a doctor and as a business owner for a few years....go for it.


As for the financial aspect of it / income potential. My first physician employee is set to clear over 300k this year, no holidays no weekends averaging about 17 patients a day. I'm on track to make close to 500k (but will end up making less than this due to re investment into the business). You can make good money owning your own practice.

I'm also up at 5am every day to work on business stuff until my kids wake up before I go to work.

 

[Chemist0157]

The average physician is grossly unprepared to run a business. The system is designed to train doctors and mostly doctor-employees. I don’t think I ever was taught anything about having a practice in training. They barely train us how to bill well lol!

I don’t think financial incentive is really enough. It’s probably more straightforward to do just more shifts yeah? I think one has to have enough ambition for other things like wanting to own and run a business for its own sake. Some people are just more entrepreneurial than others. Maybe you are one of them, but most are not.

 

[NewYorkDoctors]

If you cannot join an IPA (Independent Practice Association) to help you set up your insurance coverage and utilize collective bargaining strategies to negotiate the best reimbursement rates, then I would not even think about starting a private practice. The reason being the insurance companies have no need to pay you the proper rate if you are a small fish in the vast ocean. If you were part of a large school if fish, that is another story,

 

[Osteoth]

If you cannot join an IPA (Independent Practice Association) to help you set up your insurance coverage and utilize collective bargaining strategies to negotiate the best reimbursement rates, then I would not even think about starting a private practice. The reason being the insurance companies have no need to pay you the proper rate if you are a small fish in the vast ocean. If you were part of a large school if fish, that is another story,

How does an IPA work?

 

[NewYorkDoctors]

How does an IPA work?

It's like a professional "Club?" Only you dont have to make friends with anyone. Usually a few existing members need to vouch for you and write letters of recommendation for you.

Independent Physician Associations (IPAs) Definition

Read the AAFP's guiding principles for establishing independent physicians associations definition and the benefits to business.

www.aafp.org

Therefore make some friends and networking. Alternatively, maybe save the life of an existing member or be the child of an existing member?

 

[fooli_doc]

I think you really have to enjoy the business/managing aspect of it. Otherwise, I can't see it as even close to worth it. You can do extremely well employed in the outpatient setting, but it also won't be worth it if you hate outpatient medicine. In my opinion working 4 or 4.5 days per week, no weekends/nights/holidays, no administrative duties and making ~$300k is about as optimal as it gets for balancing earning potential and enjoying life. I look at a $260k nocturnist job as absolutely criminal.