Looking Back on Switching to Private Practice

For those of you on Facebook, you know how each day it provides you with your memories? It is something you posted a year, two years or 10 years ago, like a "this day in history"? 

Well, last month, Facebook reminded me of one my blog entries.  It was from seven years ago, when I left being an employed physician in a faculty practice and went into solo private practice. 

As I read it, I remember the trepidation I had as well as the excitement. It took a lot of research and soul-searching before I made that final decision. It was scary and sad. I had made good friends at that practice. I remember going to my senior partner with the news I was leaving. I had practiced my speech a hundred times before I walked into his office. And yet, when I started to speak, I couldn't help but cry. He told me later that he was sure I was going to tell him I was pregnant. I told him that I had done a lot of thinking and that I had decided it would be best for me to go into private practice. He was very surprised. I hadn't given any indication that I was unhappy there (other than the usual daily gripe we all did) and in truth it wasn't that I wasn't happy. I just wanted to be happier. He asked me why I was crying. I said it was like breaking up with someone. You're sad that it's ending but you also know ending it is the right thing to do. 

It was then I had to go to our department chief.  I let him know of my decision.  He, too, was surprised.  I know it's silly and incredibly vain, but I was a little disappointed that he didn't make some attempt to change my mind.  No "are you sure?", "is there anything we can do to change your mind?" The answer would have been "no" but after 8 years, it would have felt nice if he had at least asked. 

So it's been seven years.  Wow.  It's hard for me to believe it's been that long.  The practice has grown.  Things aren't exactly as I laid it out in my business plan (yes, I had a formally drafted business plan). I grossly underestimated the time necessary for phone calls and paperwork, so instead of scheduling 26-30 patients a day, it's more 18-24.  Some things turned out to be less expensive than I thought, malpractice insurance, for example, and some things are more expensive.  I didn't think I would need so many phone lines!  Housekeeping costs less and marketing is now non-existent.  EHR costs have gone up with all the upgrades to keep up with Meaningful Use.  I don't have the nurse practitioner I thought I would.

So, am I happier?  Most days.  There are days I wish I could turn off being a business owner.  But I couldn't go back to being employed.  I've had companies ask about buying me out and administering the practice.  I can't.  It's my baby.  Sometimes I want to put the baby in time-out, and I know some things would just be easier for me if I relinquished some responsibility, but I can't; this is my show, and I glad I made the change.