Private practice

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

potatoplease

Full Member
10+ Year Member
15+ Year Member
Joined
Mar 10, 2008
Messages
84
Reaction score
0
How does private practice work? All the hospitals I've ever been to are affiliated with medical schools so they are academic centers (I guess non-profit). I've never actually seen a private practice.

Are there actually hospitals that are entirely private? Or is it mostly small clinics like a radiology center, etc.
 
There are plenty of large private hospitals.
 
Once you are licensed to practice medicine and you have completed your training, you are going to (want to) get a job. Private practice is a job. Today, most physicians work it group practices and the group hires newly trained physicians to be part of the group. Solo practice (without partners) is less common today but it might be practical in psychiatry where the overhead is very low.

I'm not clear on the ownership of practices but clearly there are costs associated with establishing and operating a practice (the office and its furnishing, the billing system (often computerized), the medical records system, durable equipment, nalpractice insurance, etc). Someone has to make the investment but I think that most new docs are invited to work for a practice with the possibility of "buying in" after they've established themselves.

At the same time that you are choosing and being chosen for a group practice, you are applying for admitting privileges at one or more local hospitals. You benefit by having a place to treat patients who need inpatient care and the hospital benefits by having "paying customers" come through the door. The hospital however, doesn't let in just anyone and will look at your credentials to be sure that you aren't going to make a mess of things and bring shame to the hospital's good name.

Now in private practice, patients come to see you, you bill them and they (or their insurance company) pay you. You may sign contracts with insurance companies to accept what the company is willing to pay in exchange for being a "preferred provider". People covered by that insurance company will have a financial incentive to see a preferred provider and that will drive patients to your practice. The down side is that sometimes you'll feel that the insurance company is paying you too little and that can cause some consternation.

Long story short - you'll get a job taking care of patients and you'll generate income through the provision of medical care.
 
I agree with the above post. I worked at an academic hospital that was a primary teaching affiliate of a medical school. The particular department I worked in, all of the physicians received a private practice salary. In addition, they received all of the benefits of being a professor at this particular university, such as 100% college tuition reimbursement for their children, research, teaching, access to clinics, etc. This clearly is an amazing situation to be in. However, from my experience this is rare and it is extremely competitive to obtain. Just another side to academic medicine many students are not aware of.
 
I agree with the above post. I worked at an academic hospital that was a primary teaching affiliate of a medical school. The particular department I worked in, all of the physicians received a private practice salary. In addition, they received all of the benefits of being a professor at this particular university, such as 100% college tuition reimbursement for their children, research, teaching, access to clinics, etc. This clearly is an amazing situation to be in. However, from my experience this is rare and it is extremely competitive to obtain. Just another side to academic medicine many students are not aware of.


That is rare. More often the tuition benefit and all the other perks go only to faculty who draw a salary from the university, rather than those who support themselves through private practice and have an appointment as a voluntary member of the faculty (meaning that one's relationship to the medical school is that of a volunteer).
 
I'm not clear on the ownership of practices but clearly there are costs associated with establishing and operating a practice (the office and its furnishing, the billing system (often computerized), the medical records system, durable equipment, nalpractice insurance, etc). Someone has to make the investment but I think that most new docs are invited to work for a practice with the possibility of "buying in" after they've established themselves.

Now in private practice, patients come to see you, you bill them and they (or their insurance company) pay you. You may sign contracts with insurance companies to accept what the company is willing to pay in exchange for being a "preferred provider". People covered by that insurance company will have a financial incentive to see a preferred provider and that will drive patients to your practice. The down side is that sometimes you'll feel that the insurance company is paying you too little and that can cause some consternation.

Lizzm makes the medical points, I can add a few items from a sibling who has their own private practice, and started it around 5-10 years ago. Their path was to finish training in the specialty, then work for mid-sized groups for around 5 years, and then after building up a clientele, to start a private practice. There are lending institutions/consulting groups that assist in all setup functions, from hardware to computer applications to office furniture to lending funds needed to do this.

A thought (from my professional experience) is how to get clients - there will likely be a fair amount of repeat clients over time for a field like FP, but initially there will probably be both marketing expenses and downtime, a pre-existing patient body would be helpful here, although many practices have "noncompete" type clauses that would limit a physician from bringing their clients with them.

Some specialties (i.e. plastic surgeons) market heavily, do a google search on plastic surgery & your city and check this out. Physicians in this type of specialty earn much more from a major cosmetic procedure than removing a mole, for example, and would not have the same type of "repeat business" that a family practitioner would likely enjoy.

A downpoint of private practice, in addition to malpractice and patient insurance issues, is that you're running a small business, and will have lots of issues outside medicine to deal with; some MDs/DOs would not enjoy this. You're the one who would need to ultimately hire & fire staff, discipline staff when they make mistakes, figure out how to handle workload when your office manager goes on maternity leave, etc.
 
A downpoint of private practice, in addition to malpractice and patient insurance issues, is that you're running a small business, and will have lots of issues outside medicine to deal with; some MDs/DOs would not enjoy this. You're the one who would need to ultimately hire & fire staff, discipline staff when they make mistakes, figure out how to handle workload when your office manager goes on maternity leave, etc.


I think that this might be very frustrating, but also satisfying. I think I would enjoy running a small business and getting to be my own boss. Tough, but worthwhile. A pediatrician I've been shadowing owns her own practice and has a partner and office manager. She started out in group practice, but disagreed with a lot of the docs' proceedures, so started her own. She's been extremely successful partly because she is very diligent about fighting the insurance companies. I think that if done well, private practice can be quite lucrative as well as meaningul. Do other people think this or is everyone aiming for hospital based medicine these days?
 
Honestly, I don't really see any group practices. All I see are large hospitals, either affiliated with a med school or by itself, or just solo/small family medicine practices. Can group practices operate within hospitals? I just don't see how they fit in when there are already so many hospitals.

And about the hospital referring patients to group practices, why is that necessary? Hospitals are independent and have all the departments you can think of. Why would they refer patients to some group practice outside the hospital?
 
Honestly, I don't really see any group practices. All I see are large hospitals, either affiliated with a med school or by itself, or just solo/small family medicine practices. Can group practices operate within hospitals? I just don't see how they fit in when there are already so many hospitals.

And about the hospital referring patients to group practices, why is that necessary? Hospitals are independent and have all the departments you can think of. Why would they refer patients to some group practice outside the hospital?

You need to get out more. Group practices are EVERYWHERE. Most people who go to the doctor aren't going to the hospital. They are going to some medical office building, where one or more groups operate. I think most of us weren't aware that so many people went to the hospital for primary doctor visits until we worked there. Open up the local yellow pages and look up, eg. pediatrician and you will see nothing but doctors in private practice -- very few hospital listings. Some group practices work in conjunction with hospitals -- it's not uncommon for a hospital to outsource its ED to an ED practice, or have local radiologists, cardiologists, etc having privileges and working a few days a week in the hospital. As for why to refer patients to group practices, hospitals are lousy places through which to get your primary care services; it's not designed for that.
 
Top