They tried to discourage me from starting a solo medical practice

Originally published by Ho Sun on December 21, 2010

I keep meaning to talk about my office planning, but I keep getting sidetracked with other topics on my mind.

This post will actually be a personal reflection rather than anything else.

One post on Sermo talked about a primary care physician who was considering to close doors because of financial difficulties with his practice (  It looks like this guy signed up with the wrong physician practice management company (PPMC), and they were sucking him dry.  Based on my 10 minute research, it sounds like these companies are akin to taking on a pimp.  By signing on with a PPMC, you would allow it acquire controlling interest of your practice through a buyout.  The PPMC would then manage the administrative aspects of your practice in return for a regular cut of your profits.  Obviously, you would forfeit much of your autonomy.

Over 200 people replied to this post, and a good number described similar experiences.   It really paints a bleak picture of the viability of a solo practice these days.  The days where a starving physician didn’t exist  seem to be gone.  Although my situation does not necessarily mirror this guy, I concede to the fact that I may be susceptible to similar market forces.

Although I have no doubts or regrets, I like to reflect on my career choice every now and then.

Back in residency, every single one of my solo practice attendings praised my career move, saying that it was one of the best things they had ever done.  Of course, being in their late 40s to 60s, most of these guys started out in a different environment.  Nevertheless, everyone was very supportive of my decision.  One even told me that he couldn’t see me doing anything else.   This same attending also thought that the high volume practice in Las Vegas would have been the wrong choice for me.

In contrast, my plans have met much resistance and reservations from random ophthalmologists I’ve encountered in the community and at AAO, especially being right out of residency.  They warned me how existing practices are likely to close doors in this uncertain environment, and that I couldn’t have chosen a worse time.  I’m sure that their remarks hold some merit.  Not having personally witnessed the transformation of the healthcare world, I really can’t refute their argument.   All I can do is hope that I have what it takes to survive despite the current circumstances.

Although these comments are meant to be words of wisdom, I just can’t help but get defensive and irritated whenever I hear the same spiel.  What annoys me the most is when they suggest that I should drop everything and pursue a different route when they know that I’m already past the point of no return.  I just wish that these people would understand that I didn’t come to this decision easily, having gone through much soul-searching before taking the leap. I’m fully aware that ruin is a distinct possibility, but I’d rather not have people who don’t know me try to deem it an inevitable fate for me.

Having only 2 residents a year, I developed very close and intimate relationships with my attendings in residency.  At this point, I consider most of them as big brothers and sisters or parental figures, rather than instructors and professors.  I doubt their support of my career choice was more than just lip service.  They’ve all come to know who I am, and I’m hoping that their confidence holds more weight than some random ophthalmologist.

Regardless of what anyone else thinks, I still need to take a shot at my dreams.   Starting this whole process, I understood that I would be attempting to climb the steeper side of the mountain in unfriendly weather, especially since I chose to set up shop in one of the most saturated and competitive areas in the country. However, I know myself best, and I’ve always believed that I had the right faculties and mindset to maximize my chance of success.

Well, this post was more of a cathartic rant for me, than anything informative for you.  Thanks for reading up to this point. With such big ventures, I would imagine everyone experiences similar anxieties. So, if you’re planning your practice as you read this blog, you’re not alone.

Howie’s note: throughout the last 30 years, there is truth that it has become harder and harder to start a solo practice. If it’s not one thing it’s another- HMOs in the 1980s, the affordable care act in 2009, EHRs and quality measures, consolidation of health care. Guess what, young ophthalmologists are still interested in starting their own practice from scratch or buying a existing practice! Paradoxically it frequently is easier to deal with the above “challenges” as a solo doctor rather than part of a group! It is definitely still possible to go solo and thrive.

Despite commonly held beliefs among those who work in groups, solo practice is well and alive. And much to my surprise many of the docs in our google group are in urban competitive saturated areas. It’s probably because no senior partner will give them a good deal, whereas in rural or less attractive localities practice owners have to play nice to get docs to work there. There’s always room for someone with good clinical skills that has good bedside manner.

I agree with Ho Sun that many doctors actively discourage younger docs from starting a solo practice. A recent study by the AAO (American Academy of Ophthalmology) showed that only 1-2% of residents are interested in solo practice. Ho Sun and I believe that the AAO perpetuates this by not even discussing solo practice as a model- it’s academics vs group vs employed by healthcare organization or government. At the annual meeting symposia and courses, when they talk about private practice, the topics are how to negotiate your employment contract, or how to fit in with the group, rather than how to start or run your own practice. We’re out to change that by writing this blog.

Once you go through opening your practice, you realize it isn’t rocket science to do so (but don’t spend your money in the wrong places), and that anyone who is smart enough to learn how to do cataract surgery safely can do it.

In fact, now when I talk with Ho Sun or other members of our google group, we actually miss the days when we were dirt broke and seeing five patients per day, and weren’t sure if our practice would succeed. If you’re in a group practice or academics and like your job and are getting paid fairly, by all means stay there, but if you’re getting all the postops dumped on you, or doing forty cases a week and getting paid only $300,000, we want you to know there are other alternatives such as solo practice.

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