Why I Have Stayed in Independent Practice

By: Daniel Hoffman

In 1978, I decided to open a general practice on the north end of a city in Central Illinois. I had no experience or training of any kind in starting a practice.

I rented a small office in a strip mall. The local bank gave me a loan so that I could put in three exam rooms, two bathrooms, a waiting area, and small room for a desk and books. I hired a young lady who could answer the phone and type. In those days, marketing was limited to putting an announcement in the paper that you were in practice. My first day I saw six patients.

It grew from there and eventually I was able to hire a girl to assist on the clinical side of the practice. The area I had rented also had two other offices, which I absorbed as time passed. I ended up with a 3400 sq foot office and seven exam rooms. These days, I have seven employees trying to keep up with me, while I work five-and-a-half days a week. Also, I make rounds at the hospital after I close the office.

Over the years, medicine has changed. The three hospitals started buying the practices. They made me an offer, which I declined. I could not see working for a salary and letting the hospital make a profit off of all the time I spent building the practice. As an employee, I would not have tax deductions and thus would owe a lot more in taxes. My salary would be controlled and benefits would be out of my hands. The hospital offed a 401K, disability insurance, health insurance and basic malpractice coverage. On my own, I chose better health insurance, nursing home insurance, group and individual disability insurance, an employer- vested retirement plan, and much higher limits on the malpractice insurance.

Naturally, it hasn't all been peaches and cream. I am the last independent primary care on staff. I have no coverage as the hospital physicians will not help with call. I tried recruiting but we have a whole generation of doctors who want a job not a profession. Computers and ICD-10 have not been my friends.

Despite all of this, I refuse to give up. I am now the oldest active physician in my department and one of the few left in primary care who still makes his own hospital rounds. Someday, I will have to retire if I ever develop physical or mental problems but that day is not now. Sadly, I will be leaving behind a whole generation of physicians that are employees being disconnected from the people they provide care.

Being independent has its price but I feel close to the people I provide care. Besides I was never good at taking orders so being a hospital employee would have resulted in me getting fired when it came down to a decision of cost vs patient care. The real test will be when I decide to retire. Will the hospitals buy the practice or let it dissolve? Do I have enough in retirement vs their 401K plans? In any event, it has been a hell of a ride to this point and I would not have missed it for anything.