What medical specialties allow you to have your own practice ?

[KMNDR12]

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I mean specialties that allow you to start a practice and work alone so you can control your work hours.

 

[LizzyM]

Outpatient psychiatry.

Solo practice is pretty much on the way out otherwise, afaik.

 

[LikeDaniel]

Gonnif, would your appraisal change at all if the question were about starting a group practice? Something like a 5-10 physician outpatient center.

 

[VincentAdultman]

Gonnif, would your appraisal change at all if the question were about starting a group practice? Something like a 5-10 physician outpatient center.

I know guys fromn residency who have opened up independent two man shops. It's early going for those guys, and they'll prolly add more partners as time goes on I imagine.

My point is it's possible but lots of work.

 

[DBC03]

From what I've heard a lot of issues stem from reimbursement rates for the hospitals vs private practice (hospitals get better reimbursements, so it can be difficult to stay in private practice). Do any of the actual physicians or medical gurus know more about this?

 

[numbersloth]

Outpatient psychiatry.

Solo practice is pretty much on the way out otherwise, afaik.

Do you think this will be a continuing trend or part of a cycle?

 

[Winged Scapula]

IRT: contracts and reimbursement

The reason so many PP have poor contracts is that:

1) they don't negotiate
2) they don't offer a service that others can't/don't cover as many lives etc

Our contracts are excellent but it didn't come without being proactive, renegotiating and showing the private payers that they need us. Surgery is still open to PP.

However, I will concede that a SOLO practice is hard to do. I know some that do it but why not have a partner? The fixed costs (electricity, mortgage/lease, employee salaries, etc. are cheaper when divided by 2 or more). Plus call/vacation is a nightmare by yourself.

 

[Winged Scapula]

Can you comment on practices that have exclusive contract to staff certain hospital depts? For example, the smaller hospital system hase essentially outsourced its ER to a private practice which acts as staff? Is this a widespread organizational structure?

I can't comment on how widespread it is, but I've certainly seen it.

We have hospitals that contract with Radiology and Anesthesia groups, and another local hospital has contracted with a local oncology group to provide those services. In the latter, the benefit to the oncologic group was increased referral source (within an ACO/ACN) and reduced prices on chemotherapeutic agents; the benefit to the hospital was aligning themselves with large group with a good reputation and presumably more resources for their network.

The physicians are not actually employed by the hospital so they can still run their practice they way they want (e.g., the hospital doesn't tell them when to take vacation, how much, how to structure the pay etc). The hospital gets coverage (which is what lead hospitals to employ surgeons, for example) and the group gets stability.

In the end, I also envision these arrangements in terms of money: someone is making it, and its usually not the physicians.

 

[DBC03]

Can anyone comment on the specific Medicare/Medicaid reimbursement for private vs hospital practices? It seems like there may be some leeway with private insurance depending on how well you negotiate, but would Medicare/Medicaid be set at the national level?

 

[Winged Scapula]

Can anyone comment on the specific Medicare/Medicaid reimbursement for private vs hospital practices? It seems like there may be some leeway with private insurance depending on how well you negotiate, but would Medicare/Medicaid be set at the national level?

There is no difference. Medicare rates are set and do not differ whether you have a hospital owned or private practice.

As a matter fact I know this because a multi state company recently approached our practice in regards to purchasing it, claiming they could get us better contracts.

When we sat down and crunched the numbers it didn't make sense because they were going to charge us a management fee and of course would be unable, by their own admission, to negotiate Medicare, tricare, other governmental contracts for us.

In fact, if I see a patient in the hospital I make less money than I do if I see them in my office because of the location of service; I lose out on the facility P when I do it in the hospital.

 

[Goro]

I mean specialties that allow you to start a practice and work alone so you can control your work hours.

OMM/NMM. A practitioner is a well to do area can clear as much as any decent dermatologist, and with less overhead at that.