Private Practice Is Challenging, But Even More Rewarding

It’s often said that independent physicians enjoy the flexibility that comes from being on their own, the owner of their own business, and the driver of their destinies.

This flexibility helps them define the culture of their practices and have the final say about the direction of the practice, including patient volume, the hiring of staff, and implementing new technologies to better manage day-to-day operations.

Employment trend not all it seems
Even as the trend seems to be toward employed physicians, especially among those who are under 40, many doctors remain steadfast in their desire to maintain their entrepreneurial spirit and are building practices based on their own personal and professional goals.

In regard to operating an independent practice, there are certainly pros and cons. Ultimately, it's up to the individual physician to decide what he or she wants out of a career and from their lives. For those entering the field, there’s much to consider—do you go for the comfort and stability of employment and give up the autonomy that comes with independent practice?

The challenge of independent practice is clear. According to Medical Economics, “Growing regulatory pressures, privacy rules, the burdens of billing and collections, steep investments to incorporate electronic health record (EHR) systems, and onerous requirements of data collection are all difficult to manage on one’s own. These forces, coupled with declining revenues, are causing more doctors in small practices to consider employment over independence.”

However, the pros of private practice still outweigh the lure of a steady paycheck for many providers. An example of this can be found among orthopedic surgeons, a population that seem to be among the employment holdouts, at least according to the American Academy of Orthopaedic Surgeons. Census data from 2010 suggests that more than 40% of orthopedic surgeons are still in private practice and 20% of those physicians are in solo practitioners. Only 8% of those surveyed reported being employed by hospitals.

According to respondents of this particular survey, a major advantage listed of maintaining a private practice is the autonomy the physicians claim over their careers and their professional lives. “They can make decisions based on care instead of hospital policy, and they can change processes more quickly because they are smaller than hospitals.”

Of course, physicians in small practices must continue to adapt, change, grow, and evolve with the times—probably more aggressively than their hospital-employed counterparts. Luckily, for those willing to take the risk, there are more and better options to help them meet the challenges as well.

Independent impulse really remains strong
The impulse to remain independent is still strong among a significant number of doctors in practice today, reports Medical Economics. Based on the results of a 2012 survey of more than 5,000 physicians, conducted by The Doctors Company, 56% of respondents said they were unlikely to change practice models in the coming few years.

Flexibility and autonomy don’t end with being the boss of a business; the concepts have deeper roots than that. Work life balance is important, of course, but so is patient care. Many solo practitioners say they have a stronger bond with their patients than those who work in health systems or hospital-owned practices. From a patient perspective, receiving care at a large practice means they’re likely not seeing the same physician every time they seek an examination, and there’s a good chance that their doctor (or doctors) do not know them personally nor are they likely to be highly involved in all aspects of their care. In many cases, small practice physicians not only know their patients, but they also get to know their families and their patient’s stories beyond their health.

Independence offers flexibility, options, and higher satisfaction
For those leading independent practices, they also are able to engage in all areas of the business they run and become more well-rounded. For providers who have a passion for the business side of care or like to have a say in decisions, they get everything they want.  They have a voice in everything from HR and marketing to managing finances, IT, contract negotiation, revenue cycle management, and facility management.

For a doctor who wants the independence but doesn’t want to manage the day-to-day, it is actually easier for a small practice to outsource many billing and office tasks affordably. There is less bureaucracy and decisions can be made more quickly. A nimble practice like this can shift to outsourced tasks or take back tasks much more easily. This is part of the flexibility that is so appealing.

Finally, according to a 2014 survey conducted by Medscape, self-employed doctors are somewhat more satisfied with their situation than are employed doctors. Additionally, about 70% of physicians who left employment in favor of self-employment are happier now. Only 9% who went to self-employment are unhappier now. According to the study, in contrast, less than half (49%) of physicians who left self-employment for employment are happier now, and a quarter (25%) are unhappier now. All in all, those responses seem indicative of a sentiment towards independence.

“I am so lucky,” says Michelle Meyer-Ban, RNC, MSN, WHNP-BC, a board certified Women's Health Nurse Practitioner who went out on her own. “It has only been five years, and I have grown to this point, which is just amazing. The practice model and the technology fit with and support my professional and personal goals. And I would just reiterate that this endeavor is totally possible for anyone. You can go into private practice and create a thriving practice with the right technology that lets you keep costs low and be efficient.”