Which specialties can you go solo?

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Merely

Merely

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Aside from FM, what other specialties can go solo after residency and essentially start up their own clinic?
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Psychiatry.
 
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The ones I know offhand are FM, IM, Peds, Psych, OB/Gyn, ENT, Urology, Ophthalmology, Derm, and probably more. Many require or are helped by having admit privileges at a hospital though.
 
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Merely said:
Aside from FM, what other specialties can go solo after residency and essentially start up their own clinic?
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Considering that medicine is a team-based profession, it's unfortunate that you're already thinking about going out on your own.
 
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Any clinic-based specialty, really. But it is going to depend on where you are practicing. In some locales, FM can open no problem. In other areas, patients expect you to be part of the larger healthcare system in town. It just depends.
 
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PM&R (know of a family friend who is private practice)
 
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It's probably too hard to just finish residency and open up shop in anything else but Psych right now, unless you have a family member who is willing to act as a line of credit to get you started. I am also interested in PP (in either Psych or Pain) and did a rough estimation of the costs for a year, and it's pretty daunting to say the least given you start with no patients and aren't sure how you make it. I'm told it all falls into place, but I think unless you're business-inclined and can see numbers and keep costs down, it would be tough in something like IM
 
Ortho. Although you either need to have hospital privileges or have your own surgery center. From my experience it isn't uncommon for a group of orthopedist to own a surgery center together but to all have their own private clinics.


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You could essentially do every specialty on your own if desired, bar some CT and neurosurgery. You could probably even just do Path while takin a **** at home.

It would definitely take some preparation and a lot of research and some business acumen but it all can be done. Ambulatory surgery centers are poppin up everywhere now.
 
If that's the case, why do I see people on here saying were moving towards the corporatization of medicine and that in 10 or 20 years there will no longer be PP in any specialty but FM?
 
Merely said:
If that's the case, why do I see people on here saying were moving towards the corporatization of medicine and that in 10 or 20 years there will no longer be PP in any specialty but FM?
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From my understanding, the realm outside of academic medicine is very different than what is typically seen for students. It is solely based on your RVU numbers, and your efficiency. Some of it falls on where you went to school and prestige but I don't think it carries much weight at the post-training level. The healthcare system from the business side is so freakin complex it's not even funny. I foresee the downfall of big non-academic hospitals because they're too costly and inefficient and the popping up of specialized centers for each specialty instead. These can be run by various physician groups or just outside investors. Neurosurg and CT surgery I feel are really the only two specialties that are limited to the inside walls of a hospital.

my sources of this is having hospital admin in the family. Obviously I don't understand the full scope of it all, and most admin actually don't because it's so interconnected. but this is my general idea.
 
Merely said:
If that's the case, why do I see people on here saying were moving towards the corporatization of medicine and that in 10 or 20 years there will no longer be PP in any specialty but FM?
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Because the economics of PP are a beast to deal with. What most people are talking about when they say PP is dead, is that SOLO private practice is dead. It is very hard to bring in enough dough to pay for support staff, office staff, billing, benefits and also take vacations when you are the only source of revenue. This is still very possible in certain specialties, like Psych. Similarly, a lot of physicians do not want to deal with running a business so hospital systems buy them out, corporatize their practice and then it's done.

But when it comes down to it, billings and collections over the past 20 years have slowly morphed to pay out more to hospital systems than to individual providers.
 
Merely said:
If that's the case, why do I see people on here saying were moving towards the corporatization of medicine and that in 10 or 20 years there will no longer be PP in any specialty but FM?
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Just because something is POSSIBLE doesn't mean it's fiscally REASONABLE. With ever increasing regulations, solo PP is becoming more and more onerous, not to mention you typically have absolutely no bargaining power with insurance companies as a solo physician.
 
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Frankly, I don't think SOLO private practice is that desirable to the current generation of med students, at any rate. Being always at the beck and call of your patients 24/7, 365/year without any partners to take up the slack and allow you to enjoy your life would be a deal breaker for me.

With that said, the nightmare scenario is one where private practice as a whole becomes extinct and your only option is to be an employee of a hospital/corporate health system/contract management group. Under that reality, our salaries would likely plunge to the level of a corporate middle manager: think mid 100's, 200k max. Don't let current employed salaries fool you: they are only that high because private practice is still an alternate option and they have no choice but to offer competitive rates commensurate with what you could make in PP in order to attract candidates.

So we should be more concerned about the health of multi-specialty and large single-specialty groups where physicians are equity stakeholders and keep all the revenue they generate. That gives you the happy balance of lifestyle flexibility provided by having partners while also "eating what you kill" rather than getting whatever crumbs your corporate overlords deign to give you.

But I'm not very optimistic about the long term feasibility of any form of private practice, even large multi-specialty groups. The government, the hospitals, the insurance companies, and Wall Street all seem to be in cahoots to transform medicine into a corporitized model. You can see it in the way the government structures reimbursement to benefit hospitals over physician groups even at the cost of spending more of its own money than would otherwise be the case. I have my own ideas of what the end game is but I think you guys can figure that out..
 
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The end game is obviously Gov't single payer healthcare.

The big question is how long before that happens? 10 years? 20 years? Any wagers?
 
My question was about solo PP....you guys were saying everything is possible (meaning you can make a lot of money) in solo now you're saying nothing (other than psych and FM) is possible...which is it? lol
 
Merely said:
My question was about solo PP....you guys were saying everything is possible (meaning you can make a lot of money) in solo now you're saying nothing (other than psych and FM) is possible...which is it? lol
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Merely said:
My question was about solo PP....you guys were saying everything is possible (meaning you can make a lot of money) in solo now you're saying nothing (other than psych and FM) is possible...which is it? lol
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Everything is possible in solo PP. You can make a lot of money or you can barely scrape by. However, it is getting harder and harder to make a killing as a solo practitioner. You're trying to get a solid answer to a question every small business owner has asked before you. There is no guarantee of failure or success.
 
WedgeDawg said:
Purely outpatient primary care visits. Or geriatric primary care. You can also subspecialize and have outpatient/clinic based endocrine, rheum, cards, GI, etc.
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Didn't realize IM and FM were that similar. I've never seen or shadowed someone that did an IM residency that works outside of a hospital that didn't sub-specialize.

Completely forgot about the last part. My brain needs a vacation.:poke:
 
throwaway948738 said:
Considering that medicine is a team-based profession, it's unfortunate that you're already thinking about going out on your own.
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thats a ridiculous assumption.
what do you think, we hold hands as doctors and walk in a circle?

solo physicians are what keeps this healthcare system in check. they provide an alternative to cookie cutter hospital based hosh posh of medicine.
 
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Brahnold Bloodaxe said:
Frankly, I don't think SOLO private practice is that desirable to the current generation of med students, at any rate. Being always at the beck and call of your patients 24/7, 365/year without any partners to take up the slack and allow you to enjoy your life would be a deal breaker for me.

With that said, the nightmare scenario is one where private practice as a whole becomes extinct and your only option is to be an employee of a hospital/corporate health system/contract management group. Under that reality, our salaries would likely plunge to the level of a corporate middle manager: think mid 100's, 200k max. Don't let current employed salaries fool you: they are only that high because private practice is still an alternate option and they have no choice but to offer competitive rates commensurate with what you could make in PP in order to attract candidates.

So we should be more concerned about the health of multi-specialty and large single-specialty groups where physicians are equity stakeholders and keep all the revenue they generate. That gives you the happy balance of lifestyle flexibility provided by having partners while also "eating what you kill" rather than getting whatever crumbs your corporate overlords deign to give you.

But I'm not very optimistic about the long term feasibility of any form of private practice, even large multi-specialty groups. The government, the hospitals, the insurance companies, and Wall Street all seem to be in cahoots to transform medicine into a corporitized model. You can see it in the way the government structures reimbursement to benefit hospitals over physician groups even at the cost of spending more of its own money than would otherwise be the case. I have my own ideas of what the end game is but I think you guys can figure that out..
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Absolutely. Medicine is the last domain of the free, educated man/woman. The end game is single payer system with a very small elite tier echelon available to politicians and the ultra-wealthy.
 
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911 Turbo said:
What about neurosurgery?
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You would need hospital admit and OR privileges. Is it possible to do solo neurosurgery practice? Theoretically yes I guess, but you're likely going to have to cover call or inpatient neuro units at the hospital you have privileges at unless you own your own surgical center (as was mentioned above). Most private practice neurosurgeons are in groups.
 
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Psychiatry is probably one of the easiest fields to hang a shingle on your own. I know of some residents who did so directly out of residency; by getting on a couple of insurance panels, they were able to fill their schedules within 2-4 months.

I'm less familiar with other fields, but fields that require lower overhead and can do more cash-based practice will generally be more amenable to private/solo work.
 
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Starting my solo ophthalmology practice was the best professional decision I ever made. Nothing better than being your own boss.

Key is to watch your overhead, collect patient payments upfront, and do own billing. I only need to see four patients a day to break even.

My friend wrote a blog about it 2010-4. We're updating it to 2017 perspective. We will discuss detailed steps on how to start a practice, as well as practice management topics such as billing, coding, practice finance and accounting, hiring and managing employees, marketing, contract negotiations, etc.

It's at www.solobuildingblogs.com. We plan to publish at least 2 posts a week from now on. We look forward to everyone's interest and readership. Thanks.
 
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NickNaylor said:
Psychiatry is probably one of the easiest fields to hang a shingle on your own. I know of some residents who did so directly out of residency; by getting on a couple of insurance panels, they were able to fill their schedules within 2-4 months.

I'm less familiar with other fields, but fields that require lower overhead and can do more cash-based practice will generally be more amenable to private/solo work.
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I agree. One aspect of Psychiatry I love. No large overhead. I hope to have a small private practice that is cash only no insurance. I love doing inpatient so I want that as my primary job initially. But would hope to be able to build a practice and reputation in my area and eventually switch over. Grow the practice as I have secure funds from an employer. Also, give myself time to learn as I go so when I am solo I will know the lay of the land.
 
BigRedBeta said:
Or critical care
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I mean critical care is gonna be just great. Maybe one day we'll realize that a computer can manage a ventilator and that keeping dying people in the ICU at 10k/day is not the best use of tax dollars
 
flasheroonie said:
What do you mean by "solo?" Are you talking about being a doc in a box? Do you have any social anxieties to prevent you from working with other people? Please clarify.
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Solo has a very clear meaning when it comes to private practice. It means having your own practice without any physician partners. Used to be very common in every field (minus the few where it's logistically impossible, like EM, gas, rads, path, etc) but now pretty rare for new grads. Has nothing to do with"doc in a box" or social anxiety. It's just a specific model of private practice.
 
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flasheroonie said:
What do you mean by "solo?" Are you talking about being a doc in a box? Do you have any social anxieties to prevent you from working with other people? Please clarify.
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Who the **** invited this guy...lol
 
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