What to do if I want to be as independent as possible post-residency?

[ohioguy]

So the more I think about it the less I want to work for the man…i.e. I'd rather take a risk and work a crap ton more and be in control of what I'm doing than have a salary that's decided upon by some upper management.

As much as I'm learning, there is so much BS in pre-clinical years that I can't even imagine how much more there will be and how many asses I'll have to kiss once I get into the wards.

I think part of this also stems from how passive I think I'll be for the next decade or so until I at least complete my residency. For the most part, I'll just be studying or training, learning things that people have known long before me…not having the chance to start much of anything new.

Things I've come up with:

Start my own private practice.
Start a start-up related to biomedical devices/anything medical related.
Start my own research lab (though academic medicine isn't really far away from the man).

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[DermViser]

With healthcare reform, more and more private practices are being swallowed up by hospitals and being consolidated due to regulatory burden. It's ever more likely that doctors will be hospital employees, not private practice owners, the way dentists are. The only exception to that is probably Derm, as it is a fully outpatient specialty.

 

[Priapism4tooLong]

With healthcare reform, more and more private practices are being swallowed up by hospitals and being consolidated due to regulatory burden. It's ever more likely that doctors will be hospital employees, not private practice owners, the way dentists are. The only exception to that is probably Derm, as it is a fully outpatient specialty.

What? how is derm fully outpatient? What about severe acne cases? do you just send them home?!

 

[Dral]

What? how is derm fully outpatient? What about severe acne cases? do you just send them home?!

Yes, with a pred taper and appropriate acne meds...close follow up.

Some Derm pts will be admitted, but they can usually be managed by a primary team with Derm as a consultant. So maybe not fully OP, but pretty darn close.

 

[ohioguy]

Thanks for the responses guys. I'm not very interested in derm at this point. Perhaps a start-up that's not under the realm of a university may be the way to go.

 

[Sephiroth]

psych is pretty private-practice friendly. much less overhead compared to most specialties.

 

[FIREitUP]

add ophtho and maybe allergy/immunology to the list

 

[evilbooyaa]

Family medicine, IM, and Peds can all be primarily outpatient private practice gigs. Yes, there is a trend towards hospital employment, but I imagine in more rural areas you could still do FM without issue.

 

[DermViser]

Thanks for the responses guys. I'm not very interested in derm at this point. Perhaps a start-up that's not under the realm of a university may be the way to go.

Very interesting article regarding the disappearing of private (independent) practice, and doctors becoming employees: http://www.kevinmd.com/blog/2014/04/growing-hospital-networks-create-tension-health-reformers.html

 

[sazerac]

Direct primary care. Subscription-based insuranceless medical services, all for the price of a smart phone plan.

Patients like it because they can spend more time per visit with the doctor.

Doctors like it because without insurance and billing, overhead and paperwork goes way down.

Insurance companies like it because you handle all the BS sub-$100 cases that cost the insurance company more in labor than they are worth to reimburse.

The pros and cons of this practice model get discussed pretty regularly in the FM resident forum.

 

[croak]

So the more I think about it the less I want to work for the man…i.e. I'd rather take a risk and work a crap ton more and be in control of what I'm doing than have a salary that's decided upon by some upper management.

As much as I'm learning, there is so much BS in pre-clinical years that I can't even imagine how much more there will be and how many asses I'll have to kiss once I get into the wards.

I think part of this also stems from how passive I think I'll be for the next decade or so until I at least complete my residency. For the most part, I'll just be studying or training, learning things that people have known long before me…not having the chance to start much of anything new.

Things I've come up with:

Start my own private practice.
Start a start-up related to biomedical devices/anything medical related.
Start my own research lab (though academic medicine isn't really far away from the man).

 

[croak]

Start your own practice. Ignore the naysayers, and just do it. Throughout history the most common is excuse is: "These are bad times," to do this or that. Once you're immersed in your work you'll be too busy to look back at why you even questioned yourself. Nothing like independence, personal freedom, and taking charge or your destiny. The only failures are people who can rattle of all the reasons why they didn't do what they wanted. Don't look back and regret not doing what you want

 

[hemoglobinemia]

Direct primary care. Subscription-based insuranceless medical services, all for the price of a smart phone plan.

Patients like it because they can spend more time per visit with the doctor.

Doctors like it because without insurance and billing, overhead and paperwork goes way down.

Insurance companies like it because you handle all the BS sub-$100 cases that cost the insurance company more in labor than they are worth to reimburse.

The pros and cons of this practice model get discussed pretty regularly in the FM resident forum.

concierge medicine they call it?

 

[deleted480308]

check out any of the posts by @AtlasMD , they run a private direct care family practice. It's all devoid of medicare and insurance, simply people paying for primary care out of pocket. it seems to be great

 

[sazerac]

concierge medicine they call it?

That is an older term with some unrealistic associations. "Concierge" has often been marketed as an elite doctor on retainer for an enormous fee, for wealthy clients. Kind of like a hotel concierge at elite hotels.

Direct Primary Care is more like blue-collar concierge if you will. Seriously, children are charged $10 (ten dollars) a month to see a doctor whenever they want. DPC is not an exclusive convenience for the rich and famous.

 

[Priapism4tooLong]

hello everyone, i'm the founder of atlasmd and would be happy to answer any questions.

great thread and its nice to see that some docs still want to be independent.

yes we started as concierge medicine even though our prices are only $10-100/pt/mo. the concierge term implies to my pts that i want to do the best for them.

but i do like the new buzz term of direct primary care or direct care even b/c we seem more and more specialists moving towards insurance free practices.


and yes we have a blog, www.atlas.md/blog and our podcasts are available on itunes (search atlasmd).

DPC truly is for the masses. the unlimited visits, no copays, free procedures and wholesale medicines and labs often save our patients more money than they spend each month.

let me know how i can help or feel free to contact me directly. [email protected] and c 316.734.8096

sweet i didn't know SDN started advertising.

Guys do you want to know one of the best drugs to make you happy?.
TO MAKE YOU VERY HAPPY??!?!!?
SUPERRR HAPPY?!?!?!!?!

you might as well throw the viagra in the M&M jar.

http://www.cialis.com/

 

[evilbooyaa]

sweet i didn't know SDN started advertising.

Guys do you want to know one of the best drugs to make you happy?.
TO MAKE YOU VERY HAPPY??!?!!?
SUPERRR HAPPY?!?!?!!?!

you might as well throw the viagra in the M&M jar.

http://www.cialis.com/

... You serious with your ****ty rant?

Someone mentioned them, and so the guy came and offered more info on his system. Wow LOL.

You say viagra, then link to cialis's website. I figure with your username, you'd know the difference. Maybe that's your problem. You think you're snacking on M&Ms but they're really viagra.

 

[Priapism4tooLong]

... You serious with your ****** rant?

Someone mentioned them, and so the guy came and offered more info on his system. Wow LOL.

You say viagra, then link to cialis's website. I figure with your username, you'd know the difference. Maybe that's your problem. You think you're snacking on M&Ms but they're really viagra.

i love m&m's

 

[Mad Jack]

With healthcare reform, more and more private practices are being swallowed up by hospitals and being consolidated due to regulatory burden. It's ever more likely that doctors will be hospital employees, not private practice owners, the way dentists are. The only exception to that is probably Derm, as it is a fully outpatient specialty.

What about rheum, sleep, allergy/immunology, sports med, and psych?

 

[DermViser]

What about rheum, sleep, allergy/immunology, sports med, and psych?

• Rheum can hardly depend on ONLY outpatient practice. There is very much an inpatient consult component.
• Very difficult to have a formidable process with just Sleep patients - esp. with ratcheting reimbursements. Sleep is usually a supplement to income.
• Only Sports Med jobs (usually it's a fellowship at Family Med) without doing FM, are few in number.
• You are correct, Psych is also another possibility, although will be harder to stay in PP due to Psych NPs and having no procedures.
• Allergy/Immunology is another option but is no way assured in getting the fellowship after completing IM. It is one of the most competitive fellowships after IM. Many times called the "Derm" of IM.

 

[AtlasMD]

I would say that any out patient specialty could function well as a direct care model. Although the details may very from specialty to specialty.

 

[phonyreal98]

Start my own research lab (though academic medicine isn't really far away from the man).

Good luck getting an R01 to run a research lab these days....