My first decision was to choose between Academic/Private or some combination. Once I realized what I wanted, the flexibility of private practice, and trading some of that and income for the additional benefit of being academic, that narrowed the field. I loved where I did my training and wanted to return. I did a fellowship to provide some additional depth to my training and knowledge base as not to become too 'inbred.' I started a private practice at an academic institution (my old one) with the invitation/blessing of the department. I work with residents and care for both private and clinic patients. Granted, there is some lost in revenue but the benefits outweigh the cost. I like to teach and also control my life. I started instantly busy and work with a great group of attendings that refer to me. Having said all of this, startup of a private practice costs some money. As I am a bit of a geek, we went with all electronic charting and patient management (EMR/PM systems). You only want to do this once. and the start up cost and time is high. I cannot imagine attempting to move a paper system over to a electronic system. Serversx2, tablet, desktops x4, networking systems with connections to the office fluro machine, fax server etc. too time and money to set up. Additionally, just because you are electronic does not mean the rest of the carriers are. Many still require paper submissions so you must have a way to do that. Work related injuries will often require not just the bill but all notes, as in this situation they arrive at different times (notes from office, bill from clearinghouse or electronic) then close followup is needed. My billing staff work in the office, I do not know how this would work if you contract that work out. Anyway, thats about all I got to ramble about now!
