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Thursday, November 02, 2006

Solo Medical Practice: What Can Be Better!

Richard A Schoor MD FACS
Medicine is great profession and calling with a rigorous educational and training period but many practicing physicians admit that a doctor’s real education, medical and otherwise, starts when they enter practice. Seeing patients for real, as a certified, licensed doctor is exciting, but can be scary at first. Being in a group setting can help during this transition phase, but ultimately you will get very comfortable and competent in your new role and you may find your self longing for the sleepless nights of endless possibilities and entrepreneurial dreams that only solo practice can provide. Or you may be forced there involuntarily. Either way, when you find yourself on your own, you can be comforted by these five myths regarding group practice and why solo is actually better.

1. Solo practitioners are on constant call:
Not true. I have been in 7 man and 4 man groups and have been solo. Let me tell you; call for a group is worse, much worse. When I was in a group, I literally lived my life around the call schedule. So did my partners, and so do my friends now who are in group practice. In fact, as the group size becomes larger, the call becomes worse. By worse, I mean more phone calls, more emergencies, more hours rounding, less sleep, less time with your family, and so on. Less happiness, more anger. Call for groups becomes a real issue that can break groups apart. Partners often bicker about who has more call on which days and what weekends and how many holidays and on and on and on. And physicians in large groups dread call far more than small group or solo physicians because in a large group each individual call is that much more painful. From my own experience, my anxiety level would rise as the call day or weekend loomed closer and by Sunday evening, I’d be exhausted! And most physicians, solo or group, feel as I did. Now, as a solo guy, I never get called, do not take hospital ER call, and have no emergencies. I sometimes work on weekends, but only if I feel like it. I can chose to accept or reject consults, but on my own terms. I sleep well, have no stress, and spend time with my family, friends, and my hobbies. In short, I have no call.

2. There is safety in numbers.
While this may be true for wildlife on the Sahara, it is blatantly untrue in medical practice. I had been told, without exception, that being in a group offered protection and insulation from one of the unpleasant aspects of medicine—malpractice litigation. Untrue, untrue, untrue! This is perhaps the biggest myth and potentially the most dangerous to the young physician. As part of a busy group, not only will you get sued for things you did, but you’ll also get dragged into your partners’ mishaps. How about job security? People think that once you are partner, you're safe...on easy street. WRONG! I know several groups, personally, that have jettisoned full partners, not associates, when the firing was perceived to be advantageous to the group's survival. Solo practice is actually the safest place to be.


3. The economy of scale is better in a group practice.
The economy of scale means that the busier you get, or your group gets, the less it costs per encounter with a patient and the more profit you see. This is because, in theory, your fixed costs stay the same while your productivity (seeing patients) increases. While in certain ideal situations this might work, for the overwhelming majority of practices it is simply not true. The larger a group gets, despite the best intentions, the more that the operating and administrative costs run out of control. This is because individual doctors are individual companies with individual needs and costs. And some companies run with a high profit margin, some with a low profit margin, and some at a loss. Therefore, a well run group will always have more waste than an efficiently run solo practice.

4. Partners help you manage complex cases and the: “I like to run things by my partners” myth.
This is the one of the biggest farces. In the current age of telecommunication, internet, email, IM, video conferencing etc there is absolutely no barrier to collaborating with colleagues on complex cases. I discuss complex cases with colleagues of mine in Indiana, Chicago, India, and Great Neck on a routine basis. I can even send radiographs and histology images over the internet, of course after removing any identifying patient information. It is a fast, cheap, effective, and efficient. And you can choose colleagues who are real experts in their respective fields who are typically eager and willing to help you.

5. You need partners if you want to do complex surgery.
This is a myth. In the past, assistant surgeons received handsome reimbursements; they got paid well. Not anymore! In fact, when 2 partners double scrub, the practice loses income. In current surgical practice, an economic incentive exists that encourages surgeons to operate either by themselves or with PA’s or other paraprofessionals. So for the most part, you’re on your own anyway. But don’t worry about this. Operating independently from partners on complex cases is doable and enjoyable, and it is done frequently and safely.