Future of FM private practice

[TypeADoctor]

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I am currently nearing the end of my 3rd year of medical school. I have always been planning on going into FM and working in a more rural setting. I was hoping to someday open my own private practice or buy out a retiring doctors practice, but during a presentation/Q&A with my hospitals administration they told me and my fellow students that it is and will not be practical to have a private practice 😱. They attributed this to managed care and poor reimbursement (it would be impossible to maintain a volume needed to keep a private practice viable and profitable).

Does anyone have any insight and/or knowledge of the subject?

 

[deleted87716]

The last person I would ask for advice on the subject of private practice is someone working for a hospital system. 🙄

Private practice is not synonymous with solo practice. Private practices range in size from solo practices to large multispecialty groups like mine. The financial viability of any medical practice depends on so many variables as to make it practically impossible to answer your question definitively. Granted, solo docs are feeling the pinch of declining reimbursements more than larger groups due to the fact that they have little to no negotiating clout with third-party payers, and do not enjoy the economies of scale and shared efficiencies that make group practice attractive. Furthermore, rural physicians tend to be forced by circumstances to accept patients with virtually any type of insurance coverage, regardless of how poorly it reimburses, and they also have to contend more with self-pay/no-pay patients since there's nowhere else for them to go.

 

[deleted87716]

Good question. NYTimes put out a good article recently regarding this: http://www.nytimes.com/2011/04/23/health/23doctor.html

It's sad to see that this is the state of primary care private practice. The trend indicates that the small (less than two FM physicians) private practice is on the way out and larger, multi-specialty groups will be the majority. Increasing overhead and low-reimbursement are the major reasons cited - it's disappointing, really.

Solo practice is still viable. You just have to be willing to change with the times (see: http://www.idealmedicalpractice.com/info.html). The guy in the article clearly isn't willing to change. He's just running on the treadmill, trying to keep doing things the way he's always done them as his patients get older and sicker. 4,000 patients...? Geez. I wouldn't want that practice, either.

 

[TypeADoctor]

When I say private practice I am not excluding group practices. Speaking of which, where do you see group practices "fitting in" in the future (i.e. do you think they will remain viable, profitable, etc..)?

 

[deleted87716]

When I say private practice I am not excluding group practices. Speaking of which, where do you see group practices "fitting in" in the future (i.e. do you think they will remain viable, profitable, etc..)?

I think group practices are the future.

 

[TypeADoctor]

Something else I was considering was working for a clinic/small hospital in a rural are but also making myself a business by filling in for other clinics in the area for a weekend shift or two and maybe doing a few home calls on the side. That way by making myself a small business on the side I have my full time job security with the tax benefits of having a small business. I need to better educate myself in personal finance and how to run a small business though...

 

[deleted87716]

Something else I was considering was working for a clinic/small hospital in a rural are but also making myself a business by filling in for other clinics in the area for a weekend shift or two and maybe doing a few home calls on the side. That way by making myself a small business on the side I have my full time job security with the tax benefits of having a small business. I need to better educate myself in personal finance and how to run a small business though...

Sounds like you're planning to work all the time. There's definitely money in that. 😉

 

[TypeADoctor]

Lol, It does sound like I will be working all the time, Blue Dog. But I grew up in a very small town (about 1,000 people) and my family was borderline poor. I want my future kids to have more opportunities than I had and if that means for the first 5yrs I'm out of residency that I have to work more than I would like, I'm willing to make that sacrifice 🙂.

 

[GoodmanBrown]

Solo practice is still viable. You just have to be willing to change with the times (see: http://www.idealmedicalpractice.com/info.html). The guy in the article clearly isn't willing to change. He's just running on the treadmill, trying to keep doing things the way he's always done them as his patients get older and sicker. 4,000 patients...? Geez. I wouldn't want that practice, either.

Wow, his expenses are $420,000/yr for a solo doc. No wonder he has trouble making ends meet. I'm impressed he can break even with 3 visits/hr.