Private practice

[PowerOfWill]

I've read much about private practices having a more difficult time keeping up with regulations, red tape, and other hindrances.

1) Is it currently a viable model in general?

2) Under socialized health care and a socialist government, will it be at all possible?

Could there be such a thing as black market medicine?

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[FamilymedMD]

I'm sure there are rare exceptions but private practice paid by insurance/Medicare/Medicaid is on its deathbed. On the other hand, direct contracting with patients or employers (DPC, employer clinics) is growing and very feasible for individual physicians.

It depends. If the democratic socialists (Bernie, Warren) pass the bill they cosponsored, that would make private practice of Medicare covered services illegal. Most countries with socialized systems are less draconian than that and allow some private practice. The devil is in the details. For example, it's already a PITA to opt out of Medicare.

Maybe we can open private practices on reservations just like casinos...

 

[deleted941485]

I’d be very skeptical of any private practice. The government is in the process of killing it. Even if you find a good practice, it will not be worth trying to keep it afloat because any sweat equity you put into it will be effectively worthless especially when all of your patients transition to Medicare or Medicaid.

 

[Sushirolls]

I opened a private practice in 2019. I believe it is viable.

The momentum of change in health care is slow and the threats of Medicare for all and its different flavors will take years to even remotely make its way thru the congress. Then there are the legal challenges of limiting the practice of medicine should any clauses include banning physicians form accepting cash pay or charging for extra services.

Each specialty is different regarding the start up costs for a private practice. First division is outpatient vs hospital based. I.e. Psychiatry vs general surgery. If you require a hospital to practice your trade you need to know the local political landscape and how the hospital bylaws, call requirements, etc look like. Some hospitals, health systems, or competing medical groups will actively seek to stop your application for privileges. That then means finding a location with less bullies. They do exist.

Some specialties like Psych, IM/FM, Peds, Derm have the capacity to be cash only. Other specialties not so much. What's the local payor market like? Does private insurance pay more then medicare or LESS?

Private practice is the way to go, and highly recommend it for people, but you must know your specialty and know the political landscape and have a game plan

I am so much happier that I'm not working for a Big Box shop and now that I've crossed the wall to be amongst the free folk, I won't ever go back.

Bigger towns with bigger Big Box shops can also have incursions by private practice groups, but this means coordinating with multiple doctors to form a private practice group from the start, or getting all the Big Box shop docs to leave and form their own group. Issues of non-compete clauses in contracts present, and this is a logistical nightmare, but I suspect random blips on the radar will see this happening in the coming years.

The trend of fleeing to the Big Box shops will start to switch back in the coming years, I believe. In part because many Big Box shops are replacing doctors with ARNP and PA. Spread sheet, sure they make sense, but we all know their inferior and ARNP dangerous levels of training will lead to a slow increase in doctor only groups. Just recently I saw a patient taken off Levothyroxine and placed on armour throid by an ARNP because "it was more natural." I recently had another patient on Prazosin BID dosing because the previous ARNP was "building up the dose" for a PTSD patient. This is just the past 30 days...

Healthcare will start to fracture on Big Box shop vs Private practice, and also ARNP vs Physician groups.

Private practice is not dead by any means, but you have to have a plan.

 

[damon30]

In this day and age, you should never fully dedicate yourself to opening a private practice unless you have a) already established financial security b) an understanding of what you're doing by essentially being a business owner. Also, black market medicine? Sounds like something you see on TV shows when the high class criminal mastermind goes to a safehouse to have a bullet pulled out.