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becoming a solo practitioner

  • 1.  becoming a solo practitioner

    Posted 11-20-2017 06:57
    Hi everybody,
    I am a family practitioner in Colorado and has been with a federally qualified health center past several years since residency.  Although I enjoy seeing my patients, about 20 +/- 3 daily, largely of underserved population,  I have been considering opening my own practice but I often feel discouraged with political environment we now have.  Can you tell me what I should be thinking, anything I should expect or prepare myself? Thank you.
    S. Lee MD

  • 2.  RE: becoming a solo practitioner

    Posted 11-20-2017 14:16
    This movement started with Gordon Moore and his "solo, paperless without staff" and his renting out 1 room. He did the micropractice leveraging technology and keeping overhead super low.
    We have found comfort in knowing there is a contingent of us across the country still trying to be small, independent on this list.
    The pros of being solo are flexibility with schedule and autonomy for making all the big and small decisions. Only small independents are nimble.

    Costs are the same for everyone trying to run a "regular" practice where all one is doing is seeing patients in a regular office (that is not the micro-practice). Depending on how much you want to make, you may still need to see a decent volume of patients if you want to pay for an EHR, credit card machine, billing, assistants, cleaning service, utilities/internet. You will have no negotiating power on contracts unless you are in an IPA. You may not be able to accept certain narrow network plans.

    The first thing is to start with a business plan where you build your salary into the plan. I feel like I have posted an Excel sheet on this before but if you cannot find it, let me know.

    If you are a savvy business person (most of us are not because we are so compassionate and connected to our patients --and our strength lies being a doctor) you can find some other angle. I have had an NP student who told me the practice she is joining has a pharmacy person and they do spray tans and cosmetic! Others get a bigger space and rent it out. Others moonlight on weekends. Some get a good cash only practice going or have some other side business like weight loss.

    I have been a solo practitioner for 5 years and I am giving up now after 5 years of 24/7 call, doing payroll, cleaning, billing, hiring/firing etc. My Dad kept the Quickbooks for free. I had one great front office staff that was super smart and as invested as I was in the practice.
    I am joining up with another small independent who is better positioned to cope with the Medicare ACO, PCMH, member of an IPA .

    These 5 years have been rewarding - I had felt the burnout and lack of schedule and other autonomy from being in a larger practice and an
    employed practice. I have 2 school age kids 5 years apart but one has gone to college. I have been very close to my patients and provided good service, even drawing their blood and speaking to each and every one personally. However, I did it with a cut in pay and benefits because I had that ability with my family situation and husband's job.

    I would think there are a lot of pros to find a different employed position with guaranteed salary benefits if you are a person who has the luxury of doing the schedule that is given to you.

    I'm wondering if the Obamacare repeal goes through whether that opens the door to more small, independents and cash only practices.

    Mamatha Agrawal, MD
    Family Doctor CaryNC
    Cary, NC
    Live in Raleigh, NC
    Solo since 2012
    Practice Fusion and NueMD