Just because you are new to the community does not mean you can't survive, even thrive. As a new entrant into the market place, you may have several advantages over the established practices.
1: Flexibility—you can be flexible, adaptive, and change-ready. These are important characteristics to possess in the face of shifting reimbursements schemes, regulations, and managed care rules on top of major advances in communications and health information technologies.
2: Cream-skimming—also known as cherry picking, this allows you to actively pursue more profitable diagnoses and treatments since you are not bogged down with a sicker, more labor-intensive, and—unfairly—less profitable patient base.
3: Tech-saavy—you'll have access to low cost, yet powerful technology that is designed for smaller operations. This technology will enable you to be efficient, more cheaply.
4: Alternative delivery methods—you'll be able to find new, creative ways to see patients and deliver care and also develop alternatives ways to get new patients. Just ask Jay Parkinson MD. IM, Video Chat, text messaging, e-mail, web-site; all this will allow you to capture a sizable segment of the patient base that other established groups are not reaching.
5: Patient preference—as a solo person or a small group, you'll find that patients will be choosing you preferentially over the faceless, big name group. Who'd you chose?: Suffolk Urology, North Suffolk Urology, Central Suffolk Urology, Western Suffolk Urology, or Richard A Schoor MD PC-Urologist.
6: Regulatory changes—No question that in this regard, the advantage tends to go to the new entrant. Inertia that is always present in established practices will make operational change slow in the face of mandates such as P4P-PQRI, HIPAA, etc. In addition, large groups will respond more slowly to changes in payer mix and ironically, can be less adept and handling cash paying patients.
On the balance, as a new entrant, immature, and upstart practice, you're not as disadvantaged as you may feel you are.