Conventional Practice Options Private Practice Delivering the Best Patient Care

Most of you will enter private practice after completing residency or fellowship. In the private sector, physicians either work by themselves or with others, providing high-quality medical care to all types of patients. Because they are not tied strictly to the large academic medical centers, private practitioners have the flexibility to set up shop anywhere in the country—urban, suburban, or rural. Depending on the specialty, you may be working in the office-clinic (dermatology, rheumatology, allergy medicine), the hospital (anesthesiology, radiology, pathology), or both (internal medicine, surgery, pediatrics). Some private practitioners also make rounds at other places, like nursing homes (geriatricians, internists), state facilities (psychiatrists), and prisons (internists, family practitioners).

Although it is generally true that private practitioners earn a great deal of money, they work hard for their salary. With income directly proportional to the number of patients seen or procedures performed, their focus is on patient volume, turnover, and productivity. In return for the higher salary, private practitioners generally sacrifice the opportunity to take care of interesting, complicated cases. Unlike their colleagues in academic medicine, private practice doctors take on a greater proportion of routine bread-and-butter cases. The rare, complex diseases (zebras) are typically referred to specialists at university medical centers.

If you are interested in private practice, the two most common options are going it alone with your own practice or joining a group.

1. Solo practice:With the increasing domination of managed care, fewer physicians undertake solo practice. Those who do can either start their own practice or purchase an existing one (with its fully equipped office and established patient base). Because solo practitioners have complete financial responsibility for their operating expenses, the economic risks are substantial. Many take additional loans to cover their initial start-up and overhead costs until the practice becomes profitable. Until word-of-mouth increases their case volume, solo physicians have to work long hours building a solid patient base. So why practice on your own? For doctors with an entrepreneurial or administrative side, solo practice provides freedom and autonomy. You can create your own schedule and run your practice any way that you see fit. Without the problem of less-productive partners who could hamper profits, solo practice has a greater potential for a higher income.

2. Group practice: Most residents sign on with group practices at some point during their final year of training. In this form of private practice, two options exist: single-specialty or multispecialty groups. By sharing patient care with colleagues, you have more flexibility for scheduling issues, like on-call coverage. Being a member of a group provides an established patient base without the overhead cost of starting your own practice. Once you become a full partner in the practice and start sharing in its profits, your salary increases greatly. There are shortcomings to group practice, however. Working in a team means having less autonomy and control over one's work schedule. In fact, because senior doctors prepare the schedules, junior physicians often perform a disproportionate share of the work.

No matter what type of practice you end up having, all private physicians have to deal with many hassles. You will spend hours on the phone with managed care and third-party insurance companies. You will learn more than you ever wanted to know about securing proper reimbursement and coding diagnoses, office visits, and procedures. You will be frustrated by the high premiums for malpractice liability insurance. Additionally, private practitioners need to arrange privileges at local hospitals for either admitting or surgical purposes. Part of every day will be spent driving to different hospitals to round on patients, deliver babies, perform surgery, or administer anesthesia.

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