Planning on a private practice?

[PWA 33]

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Me and 2 very good friends are planning on starting a private practice once we get done. Now, we are going to choose the same specialty and eventually open it up if all goes to plan. I would, however, like to do EM (which you can't really do a pp in) but I don't really care as long as what I do leads to the private practice.

This would all be good if not for the political situation.

People have been telling me that if universal healthcare happens private practice won't exist anymore. Is this true? It looks like it is eventually gonna happen, definitely by the time we retire, so should we give up and I'll do EM?

 

[TheMightyAngus]

Me and 2 very good friends are planning on starting a private practice once we get done. Now, we are going to choose the same specialty and eventually open it up if all goes to plan. I would, however, like to do EM (which you can't really do a pp in) but I don't really care as long as what I do leads to the private practice.

This would all be good if not for the political situation.

People have been telling me that if universal healthcare happens private practice won't exist anymore. Is this true? It looks like it is eventually gonna happen, definitely by the time we retire, so should we give up and I'll do EM?

Where are your patients going to come from? Google ads?

 

[TMP-SMX]

Where are your patients going to come from? Google ads?

Seriously though, usually you join an existing practice and get whatever patients they want to give to you.

 

[MattD]

What do you mean when you say there's no such thing as private practice in EM? As far as I know, there's lots of pp EM peeps. granted, it's not like office visits at their own place, but they are their own corp. and contract their services to hospitals in the area. In ugrad every time I wound up in the ER* I got a bill from the ER doc's practice for his portion of the cost, separate from the hospital bill. I don't know much about it, so if I'm wrong someone hopefully will correctly, but it seems like something totally doable.


* Yes, 'every time' I wound up in the ER, as in, my body is a magnet for sharp or serrated objects 🙂 I should buy stock in Ethicon 🙂

 

[theraball]

PWa, maybe you can get double boarded in EM and IM or something, then do one day a week EM, or one weekend/month.

My goal is private practice, but maybe start in a group practice to get ahead financially.

I doubt universal health care will end private practice. Probably the opposite, in fact. The U.S. is in debt, so there's no money to pay for universal health care, so they'll try to cut reimbursements to make it work, and all the docs will flee into private practice.

 

[PWA 33]

you guys bring up a good point... how to get customers. We've been thinking of doing it like a small business starting from the ground up. Maybe we'll find a place that's dissatisfied with their healthcare or something, havn't really thought that part out yet lol.

 

[Doctor J]

you guys bring up a good point... how to get customers. We've been thinking of doing it like a small business starting from the ground up. Maybe we'll find a place that's dissatisfied with their healthcare or something, havn't really thought that part out yet lol.

Almost any primary care physician can work at a pre-existing urgent care clinic, you could do that while you build your private practice. It takes time but patients will trickle in if you advertise a minimum amount (ie, yellow pages and a big sign out front). If you're good, word of mouth will expand your practice quickly.

Really. You need a census of about 2,000 patients per physician to have a good income (from what I've heard) and it might take a year or two to get to that number. It's not impossible but the location of the practice has a huge impact on the success of such an endeavour.

 

[Law2Doc]

It's not impossible but the location of the practice has a huge impact on the success of such an endeavour.

You could make it happen if you were willing to move to a very underserved, rural part of the country where there are severely inadequate medical services for the population base. But in general folks who want to go off on their own work for an existing private practice group for a while first to learn the ropes. Private practice is very different than residency, and you probably get no exposure to the administrative parts of running a practice while in training (which are not insubstantial). So I don't see many folks doing what you suggest right out of residency -- plan on several years of working for a group before you go off on your own.

 

[la petite mort]

That's way too far away in time to even think about. 😉

 

[Blade28]

People have been telling me that if universal healthcare happens private practice won't exist anymore. Is this true?

Tough to predict! Who knows what's going to happen in the next 11+ years (which is when you'll be getting out into solo practice, at the earliest).

 

[45408]

You could make it happen if you were willing to move to a very underserved, rural part of the country where there are severely inadequate medical services for the population base. But in general folks who want to go off on their own work for an existing private practice group for a while first to learn the ropes. Private practice is very different than residency, and you probably get no exposure to the administrative parts of running a practice while in training (which are not insubstantial). So I don't see many folks doing what you suggest right out of residency -- plan on several years of working for a group before you go off on your own.

This is the guy who wants to work 3-4 months a year, or 20 hours a week. I'm not sure how well your idea would work with him. 😉

 

[riverwoman1040]

Wait, you're not in med school yet and you've already agreed to choose the same specialty as two friends?

 

[lilnoelle]

This is the guy who wants to work 3-4 months a year, or 20 hours a week. I'm not sure how well your idea would work with him. 😉

haha, I hadn't caught that.

Something the rural docs back home do.... we have three small towns with about a 30 minute drive between each town. Each town has its own surgery private practice. Each town has a hospital. The three practices recently united to one practice and they share call and now they are able to take days off/vacations where before it was much more difficult.

 

[Law2Doc]

This is the guy who wants to work 3-4 months a year, or 20 hours a week. I'm not sure how well your idea would work with him. 😉

Yeah, I don't think anyone is going to want to partner with him with that schedule anyhow so it's pretty moot. He should know that if you are going to not only work but manage a small practice that tends to push the hours up, not down. The paperwork, taxes, and daily administrative issues are a part time job themselves, so if you are going to do that and practice you can probably expect to hit the 80 hour work week pretty quickly, at least in the early few years until you get the practice going.

 

[45408]

Yeah, I don't think anyone is going to want to partner with him with that schedule anyhow so it's pretty moot. He should know that if you are going to not only work but manage a small practice that tends to push the hours up, not down. The paperwork, taxes, and daily administrative issues are a part time job themselves, so if you are going to do that and practice you can probably expect to hit the 80 hour work week pretty quickly, at least in the early few years until you get the practice going.

No, man, they're going to each work four hours a day with a convenient concatenated schedule. Problem solved.

 

[MattD]

No, man, they're going to each work four hours a day with a convenient concatenated schedule. Problem solved.

And somehow magically wind up with 2 full sized incomes!!! lolz

 

[montessori2md]

Do a "Private Practice" style practice with one of you as an OB/Gyn, one IM/ER, and one Peds, and guarantee a wait-time of 15minutes or less to patients who pay $10 over their co-pay. So an expectant mom can meet the pediatrician while in for a prenatal visit, and bring in the toddler for stitches after he dives off the kitchen counter (it's really annoying to have a toddler you drag to the ped every couple of months for this infection or that immunization and have to go see your ob for prenatal visits all the time and on the other side of town -this is the appeal of FM w/ob privileges in rural areas). Offer a flat fee for an office visit to pts. who pay cash, and advertise it in the yellow pages and the local paper.

Granted, by the time you finish residency, it's possible that no one will have to wait to see an MD or worry about having insurance pay for an office visit : ) But it's also possible that rats will have fled NYC.....

Seriously, I'd pay an extra $20 for an office visit if it meant I was guaranteed to not have to sit in the waiting room for 30 minutes and then in the exam room another 20 minutes....it would be a great ad gimmick.

 

[DocPsychosis]

Are you high? What do you think they're gonna do, abolish all private practice and force physicians to work for the state? No one is rooting for fully socialized medicine à la the UK, and the insurance companies and AMA are too powerful to let that happen anyway. Even single-payer systems like France and Canada have private docs that just take government insurance like they do now in the States.

 

[edmadison]

Seriously, I'd pay an extra $20 for an office visit if it meant I was guaranteed to not have to sit in the waiting room for 30 minutes and then in the exam room another 20 minutes....it would be a great ad gimmick.

It's a nice idea, but generally you are not allowed to collect above the rate for services in the insurance contact and if you did that with Medicare or Medicaid, you could end up in Jail.

 

[Law2Doc]

It's a nice idea, but generally you are not allowed to collect above the rate for services in the insurance contact and if you did that with Medicare or Medicaid, you could end up in Jail.

Yeah, this could only work if you did a cash only, concierge business and didn't accept any insurance. Which generally is impossible to do in "bread and butter" practices (as opposed to luxury things like cosmetic surgery) because nobody wants to pay cash for something their insurance supposedly covers. But besides, if the OP wants to only work a couple of hours/day, the wait for an appointment is going to be a lot worse than whatever deal you've got now.