The Pros and Cons of Private Practice

For my private practice, the end of 2011 marked the beginning of my ninth year in solo private practice. During that time, I have witnessed the landscape of medicine change dramatically from the period of the late 1990s when I was in medical school to the early years of the 21st century for residency training. For that same time, I have witnessed many physicians in my small town in rural southwestern Virginia enter and leave private practice. Many of my colleagues ask me why I stay in private practice. Is it the autonomy that attracts young physicians to private practice? Is it the security that attracts physicians to be employed? For my practice, the pros still outweigh the cons.

In private practice you can be your own boss. There are no office managers or practice administrators that come to me on a routine basis asking me to see more patients per day. No one asks me why I only saw two or three new patients yesterday. In my practice, we have a very high patient retention rate. Why you might ask? The patients tell me that they enjoy being able to see the same physician for each follow-up visit. They also like the very friendly atmosphere in my office. The same nurse contacts them to inform them of test results. The same front desk staff greets them and bids them farewell at each visit as well. While these traits of private practice are very nice, we in private practice must also monitor things that our employed colleagues do not have to worry with. The accounts receivable is constantly monitored by me. The IT equipment is also monitored by me. When supplies are needed, my staff informs me and the inventory is reviewed and new items are ordered as needed.

I do all the hiring in my practice. Fortunately, I have not had to terminate anyone's position as of yet and this is a very good thing. When an employee decides to leave and move on, I field the resumes of new applicants and the new employees are given their ID badge and time card; all monitored by me. Each employee's computer account is monitored by me and all paychecks are written by me. I pay all the bills and pay all the taxes due. When the end of the year comes, my accountant and I sit down and review the receivables and start tax planning for the next year.

While all the above things are happening, I am still a family medicine physician and still see my own patients each day. My nurse and I review all messages for the day and all phone calls are returned before we leave. So after reviewing all the happenings of the day and seeing the patients that come to the office for care, most would ask me why in the world I still do this and why do I place the burden solely on myself? Being a solo practitioner and trying to run an efficient practice allows me to not have to see the large numbers of patients on a daily basis that my employed colleagues are faced with. Patients are scheduled for 15- and 20-minute slots and gaps are purposely left in my schedule to accommodate the same-day call ins. While this can be a very stressful day-to-day work flow, it is nonetheless very rewarding at the end of the day. Being a responsible businessman allows me to also be able to appreciate the strains and burdens of my patients that are trying to make ends meet firsthand, and I do my best to keep their out-of-pocket costs to a minimum.

I have read too many stories about physicians being taken advantage of while they focused primarily on taking care of their patients. Being responsible for the ins and outs of my financial business allows me to continuously monitor the pulse of my practice. While I choose to not be one of those physicians that have been taken advantage of, the pros of private practice for me still outweigh the cons. Since I have been so blessed to have the ability to run a successful practice, I have also been able to successfully advise and consult new physicians entering medical practice and help them to start their own business. Who knows where I will be in 10 or 20 years from now? I can honestly say that I will stay in private practice as long as I possibly can and will continue to encourage new residency graduates to do the same. My job has given me a great deal of personal and professional satisfaction and I will stay in the trenches of private practice as long as medicine will allow me to do so.

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