If you’ve read a newspaper or visited the doctors lounge at the hospital it’s evident that people believe health care is consolidating. Many doctors believe the solo practice model is going away. While I acknowledge that it may be different for other fields such as cardiology where the equipment is more expensive, it is still very possible for ophthalmology, among other fields, to be very successful as a solo practice. Hospitals don’t really need us and aren’t as interested in acquiring our practices; most of us operate at ambulatory surgery centers. It’s still possible to build a practice through word of mouth, advertising, and primary care referrals.
Some articles in the lay press argue that the cost of purchasing equipment and technology is way too high. This is baloney- if you are selective in your purchases and especially if you can find gently used equipment, there are deals to be had out there. So the cost of computers and technology is too high? It took me $17k to buy my computers and $20k to purchase my EHR and practice management system. While $37k is a lot, if you depreciate it over five years it’s $7500 per year- which is about 2% of my total revenue.
Others argue that in order to report for quality care as mandated by Medicare with the new MARCA and MIPS requirements, that it will be too burdensome for a solo practice. Wrong again- I can link my EHR to a clinical registry (the IRIS registry theough the American Academy of Ophthalmology in case if anyone is wondering) to avoid penalties for 2019 and forward. I would even argue that since I’m not in a multi specialty group and use an ophthalmology specific EHR that it will be easier for me to meet the reporting.
Twenty years ago, most docs would hang a shingle after residency, as Ho Sun has done. But most docs in our google discussion group took my path, which is to work somewhere for a few years, sharpen your clinical skills and pay down debt, then realize the big man isn’t giving you a good deal, and then go solo.
Solo doctors can make changes to their clinic and operations quicker than a large group. We are more nimble. I would even state that I met EHR meaningful use criteria more efficiently and with less cost than my mega group. My coding is more accurate and my billing has higher collections than when I worked for my mega group. We could even save the health care system money, because there are less layers of administration to pay for.
No one can run an office more efficiently than someone who has a direct financial stake- believe it or not, I need to see only five patients per day to break even, and Ho Sun six. You can take as much vacation as you like- last year I took twenty trips with eight weeks off plus holidays! Would the “big man” ever let you do that?
Some may argue that bigger groups may have more negotiating power with insurance companies- but even my local hospital and ASC have difficulties negotiating with them. Even if they can get slightly better rates, say 10% higher, I’d rather take home 70% (after overhead) of 100% reimbursements rather than 45% (after overhead) of 110% reimbursements.
Our experience with other solo doctors in our google group is that they are more aware of the “pulse” of health care changes and what is going on. I strongly believe that physicians should have a say and stake in how health care is delivered, who pays for it, how it is paid, and what our roles in the health care system will be. It shouldn’t be just the administrators, politicians, and insurance and pharmaceutical companies planning what our futures will be. Employees are more insulated from these things while I as a solo practitioner have more of a stake. When I was working for the government or my mega group I had no clue about some of the issues I have become aware of as a solo doc. We need more physicians to go solo so they understand the challenges ahead for the field of medicine and are willing to do something about it. Compared to picking up a check every two weeks, solo docs want to have a seat at the table, which benefits all physicians, regardless of whether you are solo, work in a small group, or a big one. Unfortunately the ship may have already sailed on this, but I’m not going down quietly…
We hope that this blog encourages more of you to go into solo practice, as we believe that if there are more solo practitioners the field of ophthalmology and medicine will be strengthened. This is a huge reason why we are making our information public. It can be done! And we are here to help you accomplish this.