Hanging my shingle out...

[hawk126]

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Hello all! I'm a PGY2 and am starting to think earnestly about my career. Do I want to stay in academia? Should I go into the private world? If so, do I start my own practice or join an established group?

In this thread, I'm hoping to prompt a discussion on the merits and pitfalls of running one's own practice. Further, I'm interested in hearing from people who have experiences incorporating mid-levels into their practices. Is this worth it? What sorts of stumbling blocks have folks with PA's or NP's encountered?

Thanks!

 

[sore eye asses]

you should do botox alot. it pays really good. PAs and NPs are good at botox.

give botox away free for the first year and build an addicted client base. then, like heroin, they'll come clambering back for more sweet sauce.

you'll be rich and your clients will be temporarily less wrinkly (but no less ugly).

it's the lord's work...

 

[MOHS_01]

^ SMH


Plan on going somewhere with a real shortage if you do not want to question your decision for years on end.

 

[sore eye asses]

alright mohs-head, the gloves are coming off. at AAD this year meet me in the alley behind the convention center by the dumpster. you wear an outfit that says 'holier than thou' and i'll be dressed either as a ninja, an american airlines pilot, a journeyman electrician or your mother (you'll know which when you see me).

i'm going to teach you how to kick ass and you can show me how to hang a shingle.

p.s. i'm good at arm wrestling, so try and prepare for that.

p.p.s. don't justify this with a response. Wait, do. No, no don't. Go with your gut.

 

[DermViser]

Hello all! I'm a PGY2 and am starting to think earnestly about my career. Do I want to stay in academia? Should I go into the private world? If so, do I start my own practice or join an established group?

In this thread, I'm hoping to prompt a discussion on the merits and pitfalls of running one's own practice. Further, I'm interested in hearing from people who have experiences incorporating mid-levels into their practices. Is this worth it? What sorts of stumbling blocks have folks with PA's or NP's encountered?

Thanks!

What are you inner values?
Are you someone who wants to contribute to furthering the specialty on an intellectual level? Do you like teaching and interacting with residents and medical students and seeing their eyes light up and getting teaching awards and attending education conferences, while your malpractice and other overhead is taken care of? Do you want to be further mentored by those who are older in the specialty? Are you ok with working with other faculty members, and thus sometimes having to deal with the inner politics that results from bringing together a bunch of high achieving individuals together? Are you ok with making a lower salary in comparison to your PP friends for the tangible and intangible benefits you receive? http://dermatologytimes.modernmedic...ia-struggles-recruit-retain-dermato?page=full

Or are you someone who likes being the H.B.I.C. when it comes to running your own business, where keeping the lights on and paying bills and cranking out RVUs is top priority so you can make payroll? The ones that I've seen who go private practice, usually go to an established practice and work a bit, before taking out the loans you would need to open up a brand-spanking new practice. Now, if your family is already relatively wealthy (which in Derm, tends to have a high proportion, unfortunately), then you may not need to join an established practice.

Neither option is bad or wrong, but it's definitely something only you can really answer for yourself.

 

[MOHS_01]

alright mohs-head, the gloves are coming off. at AAD this year meet me in the alley behind the convention center by the dumpster. you wear an outfit that says 'holier than thou' and i'll be dressed either as a ninja, an american airlines pilot, a journeyman electrician or your mother (you'll know which when you see me).

i'm going to teach you how to kick ass and you can show me how to hang a shingle.

p.s. i'm good at arm wrestling, so try and prepare for that.

p.p.s. don't justify this with a response. Wait, do. No, no don't. Go with your gut.

As luck would have it -- while looking around, I found your lesson. I have it right here -- wanna see it? Heh.

 

[reno911]

I think that starting your own practice in derm is really not that hard and I have never met anyone who did it who was unhappy with their decision. However most of the people who I know well that did this, did it a while ago. I'd be a little more reluctant about starting a solo derm practice today, but not that much more reluctant. Here's a few things to keep in mind:

1. I wouldn't worry about the expense too much. You can get loans for everything. The only downside is that you'll probably need to keep living like a resident for a year or two so you can get out from under the loans fast and then you'll start to be making real money. Basically it's just delaying gratification for 1-2 years.

2. Going to a place that is underserved will make everything infinitely easier. But I think there are niches in most large, desirable cities where a derm can start a good solo practice. You just have to be a little flexible about where in that particular city you would practice.

3. If you like teaching and research, there are still opportunities in private practice (e.g. volunteer faculty or doing clinical trials in your practice). If you really love teaching and research, then just taking a full-time academic position is best.

4. Running a practice well is not really mentally a very challenging thing to do. However, it is labor-intensive. There is only so much you can delegate and everything that you do delegate you still need to monitor. Of course, the upside is that everything is done just as you want it. That's a freedom that you won't have in other practice settings. Depending on your personality type this could be worth a lot or very little.

5. By far, the most common reason why people incorporate mid-levels into their private practices is to make more money. The issue of mid-levels is multifaceted and more complicated than I want to get into right now. However, in your case you don't need to worry about that. If you're starting out on your own it will probably be at least 2 years before you'll want one. At that time, adding one shouldn't be a problem if that is what you decide to do.

 

[DermViser]

I think that starting your own practice in derm is really not that hard and I have never met anyone who did it who was unhappy with their decision. However most of the people who I know well that did this, did it a while ago. I'd be a little more reluctant about starting a solo derm practice today, but not that much more reluctant. Here's a few things to keep in mind:

1. I wouldn't worry about the expense too much. You can get loans for everything. The only downside is that you'll probably need to keep living like a resident for a year or two so you can get out from under the loans fast and then you'll start to be making real money. Basically it's just delaying gratification for 1-2 years.

2. Going to a place that is underserved will make everything infinitely easier. But I think there are niches in most large, desirable cities where a derm can start a good solo practice. You just have to be a little flexible about where in that particular city you would practice.

3. If you like teaching and research, there are still opportunities in private practice (e.g. volunteer faculty or doing clinical trials in your practice). If you really love teaching and research, then just taking a full-time academic position is best.

4. Running a practice well is not really mentally a very challenging thing to do. However, it is labor-intensive. There is only so much you can delegate and everything that you do delegate you still need to monitor. Of course, the upside is that everything is done just as you want it. That's a freedom that you won't have in other practice settings. Depending on your personality type this could be worth a lot or very little.

5. By far, the most common reason why people incorporate mid-levels into their private practices is to make more money. The issue of mid-levels is multifaceted and more complicated than I want to get into right now. However, in your case you don't need to worry about that. If you're starting out on your own it will probably be at least 2 years before you'll want one. At that time, adding one shouldn't be a problem if that is what you decide to do.

Maybe it's just me, but I actually see the risks of private practice as a good thing. I think part of the problem with the delayed gratification of first college, then medical school, and then residency (I'd say it's even harder for derm applicants, bc you can't just "pass" your classes, but have to nearly always be on top), is that the entire time someone else is calling the shots, and you have no choice but to take it. The loss of autonomy for such a huge opportunity and financial cost is unreal.

So many people in other specialties have had private practices (even in Cards, GI, etc.) getting swallowed up by hospitals due to Obamacare, ACO and PCMH crud, resulting in consolidation. I've never read of one instance of hospital consolidation of derm private practices. Derm is one of the few fields which is an inherently outpatient specialty by nature, which will thus always have private practice and non-hospital based options available. I consider us very very lucky in that regard. No other specialty has this advantage, that I can think of (ok, just realized Allergy/Immunology, which is nowhere close to being guaranteed after IM or Peds). So no matter how bad it gets, I know that Derm is one of the best "deals" one can get in medicine, that really no other specialty can match up to.