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    Choosing independence: Tips on moving to private practice

    For employed physicians seeking more autonomy and control over their careers, moving towards independent practice can be a viable option

    Jeff Gold, MD, knew something had to change as his frustrations about 20-minute limits on appointments with patients and insurance paperwork mounted. He’d joined the staff of a hospital group as a family physician after completing his residency in 2005.

    “I had no ill will toward anybody I worked for or with,” says Gold. “It was more of a systemic issue. I could no longer work for insurance companies and wanted to work for patients.”

    In December, he left his job. The following month, he started his own direct primary care practice in Marblehead, Massachusetts, a suburb of Boston. In his practice he charges patients a monthly subscription fee instead of taking insurance.

    “I think the current system needs a complete overhaul,” he says. “That’s what I’m trying to do on my own—take a small step for other doctors to realize there is a better way of doing things for us and for patients.”

    For many physicians, the decision to take a job at a hospital or large group practice is a smart, pragmatic response to the current realities of medical practice. But other doctors find they yearn for more independence than employment allows. They may leave to go into their own private practice, in some cases even buying back the equipment they used in a previous practice and starting all over again.

    Related: How to survive in independent practice

    The numbers of physicians who make the leap is relatively small. Their numbers could grow, however. “Younger doctors are virtually all going to work for someone,” says Doug Pitman, MD, a concierge primary care physician with Signature MD in Whitefish, Montana. Pitman was employed previously in a larger group practice; earlier in his 32-year career, he ran a private practice. “As they get older, after 15 years of having to toe the line and hit quotas because the bean counters are calling the shots, they may decide `I can’t stand this anymore’ and try to do a private practice.”

    Harry Nelson, JD, founder and managing partner of the Los Angeles law firm Nelson Hardiman, LLP says that in the last three years, his firm has worked with about five physicians who needed help exiting employment in hospital affiliated groups to return to private practice, compared to 35 to 40 “entrances” in the same period.

    “What I’m talking about is doctors who went into a group setting, really were unhappy with the loss of autonomy and pressures they were feeling, and made the decision to buy back equipment and supplies,” says Nelson.

    Of course, for Gold and other physicians who have taken this route, transitioning to private practice is a significant decision that requires a great deal of preparation. Here’s how to pull it off successfully.

     

    NEXT: Do your homework

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    • KeithBorglum
      As a practice management consultant, I am seeing increased flow of practice startups by physicians unhappy with their large employer for the reasons described in this article. Others face relocations due to family issues or natural disasters like Hurricane Katrina, or are facing a buy-in at an unrealistic price. Most have been in employed practice at least 3-5 years. Physicians whom have gone private can be a good source of how-to tips, but their experience is likely anecdotal, just like the physician who related not liking the bank loan terms offered (note: startup financing at excellent terms is available from a number of national banks - but likely not from your local branch loan sales person). Sometimes a combo of going private via buying a practice can be an excellent strategy, if at the right price, whether or not your convert it to cash, concierge, or retainer model. An alternative resource for help are the Certified Healthcare Business Consultants ("CHBC") at the National Society of Certified Healthcare Business Consultants (NSCHBC.org), a number of which are Editorial Consultants to Medical Economics magazine. Most work with solo and small single specialty groups. MGMA.com also has consultants, but they work only with groups of 3-or-more, mostly very large multi-specialty groups. Just like in medicine, it helps to have support from someone whom has done what you need more than once! Keith Borglum CHBC, CBB Consultant, Appraiser & Broker at MedicalPracticeManagement.com Medical Economics Editorial Consultant

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