My name is Howie Chen. I am a comprehensive ophthalmologist located in Phoenix, AZ. Unlike Ho Sun, who started from solo right out of residency, I was too scared to go out on my own immediately after training. I thought a government or group job would be safer. So my first job was with the government at the Indian Health Service. At first I was happy simply with an attending’s salary and getting to do a lot of retina lasers and injections, as well as cataract surgery. I even got to fly in a private plane six times a month to Indian reservations which was was fun at first, but those made for long days as the plane left awfully early and the Arizona heat caused lots of turbulence in the air. Additionally there was no room for growth, especially with my cataract surgery volume which was about only 80 per year. Trying to change anything required a herculean effort, and my suggestions to make the clinic more efficient were met with resistance.
At this point I was reading Ho Sun’s blog and thought about starting on my own. I even spoke with some practice startup consultants. The lay and medical press were publishing many articles about how the field of medicine was consolidating, how safety for docs was in big groups, how big groups were buying practices left and right. So instead of going solo, I thought the safest thing to do would be to join one of the biggest multi specialty groups in the Phoenix area.
Just like my first job, I was thrilled at first- the salary was good, over twice what I made in the government and well above the average for ophthalmologists. My cataract surgery volume shot up dramatically. There were some things about efficiency I was surprised at, such as how long it took to get the purchase of a OCT approved, or how I had to write a financial analysis to justify a sixth exam room at one of our offices when we had two docs and four techs (each of which needs a room to work out of) when combined we were seeing sixty patients a day.
In contrast to my solo practice, our overhead was high because the group took a big cut, probably because of the multiple level of administrators they had to pay, but we more than made up in this with volume. But changes were being made- one day they held a meeting, and told us that a certified letter would be sent to our residence with our 90 days termination without cause! But they didn’t want us to leave, all we had to do was sign a non negotiable “standardized” contract with a large restrictive covenant, among other “improvements”, to continue working there. Just their way of telling us who’s in charge.
Many other docs in different departments were leaving. I decided to join them. But I would be going out on my own. I carefully read Ho Sun’s blog (almost have it memorized) and followed his steps to start a solo practice. It took me several months to prepare everything to open doors. While it was a HUGE pay cut and drop in patients and surgeries, I actually enjoyed every minute of the startup process. People told it might be months before I broke even- I was surprised when I made a profit my second month, and it’s been uphill since then. I thought that in solo practice there would be NO chance of reaching my salary in my group practice. While I’m not there yet, I know which direction I’m heading in and should be close to Ho Sun’s numbers sometime soon.
But the biggest advantage of going solo is the freedom to make your own decisions. If I decide I need a new piece of equipment, I don’t have to go to some administrator and grovel for it- but I have to pay for it myself. If my employee isn’t doing their job the way I want, I let them know, not report to my department manager who may or may not understand, let alone do anything about it. If I want a Friday day off for a long weekend in San Diego, my patients get moved, no six week advance notice required. The point is going solo you’re your own boss and you can live with the rewards or consequences of your own decisions, not someone else’s. I’m fine with that. It’s actually worked quite well for me, as well as most of us who have chosen this route.
It’s very true that even though I’m earning less, I’m not as burnt out- it’s a pleasure for me to come to work every day to the office I chose to lease, with the equipment I purchased, working with the people I selected to hire, and seeing patients referred by docs that trust me or heard of me from their neighbors or family members that were happy with me as their ophthalmologist. You just don’t get that same feeling when you work at a practice that someone else owns, or that is corporately owned.
The ironic thing is that shortly after I left, two of my three colleagues from this job also left- to start their own solo ophthalmology practices (the other one joined a group of two). And after a few years my group SHUT DOWN their ophthalmology department and outsourced it!! So much for big groups providing job security…
I don’t regret my time with the government as it significantly improved my clinical skills, it was the equivalent doing another residency; I don’t regret my time at the big group because I got much better at cataract surgery and got efficient at seeing patients. But it’s better to have decisions made by those who actually practice, not some administrator who doesn’t understand what we do. Those of you in who have worked in ophthalmology groups know that often junior (or even senior) employees are treated less than fairly. It doesn’t do us any good if other doctors are controlled by a senior partner or administrator. We hope to show them that solo practice is a viable if not preferred option, as well as to help existing solo practitioners run their practices more efficiently.
When I started my practice there were many people who, without any expectation of compensation, offered to help me out by giving me advice for my startup. I met three practice managers who I picked their brains for advice. A ophthalmologist colleague who I met over the phone when was checking references for my EHR introduced me to a used equipment dealer saving me at least $10,000. Ho Sun’s original blog saved me at least $20,000 and a month or two of my time. Writing this blog is my way of “passing it forward” to the ophthalmic and medical community.
Ho Sun and I have shared a lot of useful information in our discussions on solo medical practice startup and management. This blog is a extension of our discussions. Much of our advice would extend to any type of medical practice, not just ophthalmology. Both of us strongly believe that the field of ophthalmology, and medicine as a whole, would benefit from more physicians going solo. There’s nothing I want more than to see other solo practitioners, especially ophthalmologists, be successful and happy.