Private practice H&N

[MediastinalTrach]

I'd like to hear from some physicians who are H&N trained and ended up choosing private practice. Why did you choose this route over academics and how has the experience been? Would be especially curious to hear from those who do free flaps in PP...

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[Pir8DeacDoc]

I don't meet the criteria for what you're asking. But as a general ent I've practiced in an adjacent town where the big PP group has a head and neck guy. I currently send him zero things from my office. And he may be booming with business. But four other local guys I share call with won't send anything. Why?
1. He does general ent as well. This may be petty. But I'm not looking to help you build a practice at my expense. Stay in your lane. If you want my cancer business then don't take my septum, Fess, tonsils etc.
2. More importantly - his partners aren't head and neck. So the few patients I've sent there if there was a complication or issue - they had no intetest in helping. I have no intetest in dealing with your post op issues. I get it. They're hard patients and difficult operations. But the after care is often more important than the initial operation. So make sure if you go PP your partners will help care for your folks. Or you're always going to be on call.

Just my humble opinion- head and neck patients need big medical centers. Well developed tumor boards. And a team of folks to care for them - including slp, nutrition, and nursing. Don't half a$$ their care.

 

[VisionaryTics]

I've recently started H&N practice with a private practice model. The group I'm joining has an established infrastructure, does flaps, mature tumor board, etc in a large, metropolitan hospital system.

Attraction for me included:
1. Ability to do my own cases. I like teaching but I like operating more, and dragging residents through straightforward cases is not interesting to me.
2. Earnings depend on my clinical output instead of research. I'm hybrid salary/wRVU based which feels more fair to me than operating day and night as head and neck attending and getting paid less than a laryngologist who sits on his ass all day but enjoys spending his spare time writing papers for academic promotion.
3. More institutional "mobility". Hard to explain, but anybody in academics knows how hard it is to change anything. In private practice, the fast and agile practices are more profitable, so there is an incentive for me to innovate processes.

With regards to flaps, I have 24/7 ENT PA coverage so feel comfortable doing complex cases and ensuring good post-op care. This was critical for me in choosing a practice but I was not interested in re-inventing the wheel to develop a flap practice at a hospital that has never done them.

With regards to above, 100% agree. No one will see you as a subspecialist if you spend most of your time ballooning sinuses and occasionally dabbling in substandard head and neck, regardless of your credentials. My goal from the beginning is 100% to be seen as a competent subspecialist in H&N, reconstruction, and another small niche I enjoy (not sinus). This means deferring lucrative sinus cases to my partners or referring physicians.

My practice is obviously very new so I'm sure I'll be more helpful in a year or two once things have matured, but so far I'm excited.

 

[millimpeter]

I've recently started H&N practice with a private practice model. The group I'm joining has an established infrastructure, does flaps, mature tumor board, etc in a large, metropolitan hospital system.

Attraction for me included:
1. Ability to do my own cases. I like teaching but I like operating more, and dragging residents through straightforward cases is not interesting to me.
2. Earnings depend on my clinical output instead of research. I'm hybrid salary/wRVU based which feels more fair to me than operating day and night as head and neck attending and getting paid less than a laryngologist who sits on his ass all day but enjoys spending his spare time writing papers for academic promotion.
3. More institutional "mobility". Hard to explain, but anybody in academics knows how hard it is to change anything. In private practice, the fast and agile practices are more profitable, so there is an incentive for me to innovate processes.

With regards to flaps, I have 24/7 ENT PA coverage so feel comfortable doing complex cases and ensuring good post-op care. This was critical for me in choosing a practice but I was not interested in re-inventing the wheel to develop a flap practice at a hospital that has never done them.

With regards to above, 100% agree. No one will see you as a subspecialist if you spend most of your time ballooning sinuses and occasionally dabbling in substandard head and neck, regardless of your credentials. My goal from the beginning is 100% to be seen as a competent subspecialist in H&N, reconstruction, and another small niche I enjoy (not sinus). This means deferring lucrative sinus cases to my partners or referring physicians.

My practice is obviously very new so I'm sure I'll be more helpful in a year or two once things have matured, but so far I'm excited.

What is the job market for this type of situation? In residency, we don't have a clear window to the PP world, hard to get a sense if this kind of practice is available in most metropolitan areas.

 

[HighPriest]

Not being a HN guy, my impression is that most metro areas you’re going to be heavily competing with employed or university-based HN.
In the major metro area near me, all of the HN that I know of are either employed by large hospitals or the university. There may be some that aren’t but I am unaware of them, which should tell you something about where I send my cases. We have a true PP HN guy in the state, but he’s on the other side of the state, not close by the major metro area. I think that setup works for that exact reason - he has the local infrastructure to do HN cases and there’s nowhere else nearby to send them.

For us, no one is going to drive two hours through traffic to go to “Local Jim’s ENT” where they have a HN guy. If I tried to do that they would argue with me about why I couldn’t just do their case myself. We have a nearby PP neuro-oto and they argue with me about going there all of the time.

But if I tell them they’re going to a major center, they’ll go.

So this depends, of course, as to whether you mean truly PP or anything non-university, but employed. You can definitely be a HN guy in a major metro area who is employed by a large hospital system that feeds you cases.