Private Practice..

[xSTALLiONx]

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If planning on pursuing private practice, does the place of residency really matter? I know if one wants to pursue research or academic life, it supposedly does (for prestige, etc..)

 

[Winged Scapula]

In some respects it does. There are certain fields and certain patient populations in which prestige or a "name" program (ie, a "name" to the lay public which does not necessarily translate into good training) means something special. This is why Dr. Ray on "Dr. 90210" constantly mentions his "Harvard training" despite the fact that he was only there 1 year. He knows people, especially the lay public and viewing audience will be impressed by that.

But beyond that, connections and relationships with colleagues are particularly important for those going into private practice (a dying breed, by the way). You will be somewhat reliant on the other physicians in the community to refer patients to you. Therefore, you might want to consider that it tends to be easier to set up a private practice in the same town in which you did your residency training in - you already know the attendings in town, the patient makeup, etc. So give some consideration to this when applying for residency.

 

[xSTALLiONx]

In some respects it does. There are certain fields and certain patient populations in which prestige or a "name" program (ie, a "name" to the lay public which does not necessarily translate into good training) means something special. This is why Dr. Ray on "Dr. 90210" constantly mentions his "Harvard training" despite the fact that he was only there 1 year. He knows people, especially the lay public and viewing audience will be impressed by that.

But beyond that, connections and relationships with colleagues are particularly important for those going into private practice (a dying breed, by the way). You will be somewhat reliant on the other physicians in the community to refer patients to you. Therefore, you might want to consider that it tends to be easier to set up a private practice in the same town in which you did your residency training in - you already know the attendings in town, the patient makeup, etc. So give some consideration to this when applying for residency.

i've heard they're a dying breed a lot recently.. why is that? My physician's building was snapped up by some health organization a couple years back and every year, there is a new sign on it. It'll say X Health Care and then suddenly it'll be Y Health Care..

Is it because it's hard to compete versus these? I love medicine but some of the thrill of medicine was starting my own practice..

 

[Iamajew]

same with me - while i like helping people and love medicine for all of the traditional reasons, i'm excited for the business-end of managing a private practice and forming long-term relationships with patients/maintaining continuity of care. The independence of having your own office must be awesome...for me, there is no other way. Why is this a dying breed?

 

[Winged Scapula]

same with me - while i like helping people and love medicine for all of the traditional reasons, i'm excited for the business-end of managing a private practice and forming long-term relationships with patients/maintaining continuity of care. The independence of having your own office must be awesome...for me, there is no other way. Why is this a dying breed?

Combination of money and lifestyle issues. It is incredibly expensive to start your own practice. Even those who purchase an existing practice from a retirning or moving physician are hit hard. A group practice allows for cheaper malpractice insurance, cheaper health insurance for your employees (as you will presumably have more employees and will get a bulk discount), splitting of costs for new equipment or other business expenses. Many physicians are eager to start their own practice but become overwhelmed with billing issues, poor reimbursement and the stress of recruiting patients and courting referrals, that it seems tempting to join an HMO or hospital practice with a guaranteed salary and malpractice insurance paid. The days of big bucks in private practice is no longer a guarantee; reimbursements and the cost of obtaining that reimbursement puts many new physician under. Many new physicians don't want to start fresh, shilling for patients. You can't just hang a shingle and expect the world to beat a path to your door. Even if you are the only specialist in town, you will be viewed as an outsider, and will still require referrals from others; FPs, Ob-Gyns or Internists who may not require referrals still have to develop enough of a patient base to make a good income.

A physician in a sole private practice has made a commitment to being on call EVERY night for the rest of his or her professional life. Your patients will call you all night, even with the most trivial questions. You will work excessive hours and take fewer vacations, because you realize that time is money, and the more you give of the former, the more you'll have of the latter. When your family and employees are depending on you for THEIR lifestye, yours will suffer. If you go on vacation, you have to provide a resource for your patients in an emergency or just everyday type of problems. Many physicians today do not want this responsibility. They would prefer to share call with a group, to be able to take a vacation and have some days off, with their pager off, every now and again.

Hope this provides just a bit of insight as to why private practice is a dying breed...

 

[Amxcvbcv]

The prospect of medical school, internship, matching, residency, all the certification exams, continuing education, etc. seems like enough to worry about without the added stress of learning small business management on top of it. While it is a romantic dream to "hang out your shingle" and be doc to the town (or suburb, I suppose) it's too stressful for me to ponder, honestly. 😛

At least at this point... 😉