When I was completing my residency, the thought of doing anything other than joining a group practice never crossed my mind. In fact, one of the things I enjoyed during my attending years at Bascom Palmer were the interactions with my colleagues. As we hear more about accountable care organizations and contract negotiations, the theme of “bigger is better” certainly recurs more frequently. That said, when I decided to leave academia, I was unsure whether to go solo or join a group. Two years into private practice, I am so thankful I chose to go solo, and I would recommend it to anyone considering starting his or her own practice.
Of course, there are downsides to solo practice, but oftentimes these disadvantages are overly weighted. For example, a group practice offers shared overhead, collegiality, and coverage for when you are on vacation. Let’s examine each of these “advantages” of group practice.
While it is true that having more physicians should bring down overhead, many times it does not. More doctors equals more space, more technicians, and possibly more equipment. Even when talking about the most expensive OCT devices, this is not overall a big cost compared with personnel, especially once tax advantages such as Section 179 and depreciation values are factored in.
If you are a cornea specialist, it might seem great to have a glaucoma specialist next door in case you have a tough case you think he or she could help with. Practically speaking, this doesn’t happen in the real world. To begin, you may have multiple offices and that specialist is in another location. Perhaps that specialist is on vacation. Even if he or she is in the office with you, that specialist will typically request to have the patient see him or her on a separate day, as you cannot both bill for a visit on the same day. It’s also great to be friends with your coworkers, but, in today’s style of practice, you are seeing so many patients in a day that you’ll barely have time to eat lunch, let alone chat with your partners.
Although you can arrange coverage easily when you’re on call, it’s actually very easy to do this in solo practice as well. Let’s now examine the advantages of solo practice.
The most obvious advantage would be control. You have complete control over who is hired, how the practice runs, when you want to take vacation, what type of health insurance you want, etc. For some, this may seem like too much control; however, a good practice manager can help guide you in the right direction. While it is true that the office makes less money while you’re not there, the reality is that when you’re in a group practice, you’re still not making any money when you’re not in the office. To negate this effect, I offer my employees an extra week of vacation if they take vacation on days I’m not in the office. This keeps everyone happy and keeps my overhead down.
On that note, overhead in solo practice can be kept very low. With EHR and practice management systems slowly replacing medical record rooms and billing specialists, a high-tech office with the latest equipment can actually run much leaner than long-standing practices.
Finally, there is the thrill. This is not some clock-in, clock-out job that you may dread heading to. This is a reflection of you, and as it grows there is tons of excitement. I find myself happy every day I wake up heading to work, and that is likely one of the greatest measures of job success.
