THE POWER OF THE DECISION
be answered , questions like : Do I want the responsibility of the surfeit administrative burdens ? Can I deal with the risk / reward anxiety of investing in my own business ? Do I have enough money saved ? Am I ready to be on my own – clinically , financially and administratively ?
The “ place ” questions relate to what is going on around you . For example is there a behemoth health care entity in your town that likes to crush its competition ? Do you really want that aggravation / challenge ? Will third-party payors in your community accept you into their panel as a credentialled provider , or will you need to go the direct-pay route with your patients ? Is there truly a need for your services , or is your region already saturated ? If your current “ place ” is not ideal , are you willing to relocate ? And will you have access to enough support staff and services in your location ?
And thirdly , the “ time ” questions are perhaps the most important . Are you still at the point in your career where you would benefit from the shepherding of a larger organization , perhaps taking advantage of the career enhancement opportunities ( e . g ., clinical training , leadership classes , business courses , etc .)? Are your family and loved ones at a point where they can support you , or are they in need of more support than a fledgling physician / business-owner can provide ? Success in business , much like success in medicine , takes time , training and mentorship ( i . e ., like the sequence of medical school , internship , residency , fellowship , etc .).
Medicine is clearly trending toward the employed-physician model . In fact , as of 2020 , the American Medical Association says that the majority of patient care physicians work outside of physician-owned medical practices . This is actually the first time the AMA has ever measured the share of physicians in private practice at less than 50 %. 1 The AMA offers a wealth of information on this topic , much of which is freely available to members and non-members alike . As I ’ ve mentioned , the AMA advises that private practice can be a good setting for a physician if you value :
• Building patient volume
• Establishing a reputation , marketing
• Evolving payment policies
The AMA even has an online Private Practice Playbook 2 that anyone can download for free and is a good place to start ( their chart on features of different practice models can be found on the adjacent page ).
In sum , my advice to the physician trying to decide on private practice vs . employed practice is the same that Polonius gave Laertes in Hamlet – to thine own self be true . There are many advantages to being in the employed-physician herd . Herds are formidable , and there is strength in numbers . But if you don ’ t feel comfortable in those settings , at least long-term , then own it – literally . Regardless , you ’ ll know you made the right decision if ( a ) you wake up looking forward to going to your work and ( b ) you are not counting the days until you retire . I ’ ve not always loved going to work , but I do love it now , and I don ’ t look to retire any time soon . Private practice is me being true to myself . Granted , I may be a medical doctor dinosaur , but dinosaurs had quite a run !
References :
1
AMA - PRESS RELEASES AMA analysis shows most physicians work outside of private practice . May 5 , 2021AMA-ASSN . ORG
2
PRIV – AMA Private Practice Playbook , from the AMA STEPS Forward ® Playbook series AMA Private Practice Playbook , downloaded , 12 / 7 / 2023 . https :// www . ama-assn . org / system / files / steps-forward-private-practice-playbook . pdf
Dr . Murphy serves on the board of directors of the American Society of Addiction Medicine and the AMA ’ s Substance Use and Pain Care Task Force . He is the immediate past president of the Kentucky Society of Addiction Medicine , a past president of GLMS and is co-director of the Kentucky Harm Reduction Coalition .
• Autonomy
• Less bureaucracy
• Personalized care for your patients
• Collaboration with a close group of like-minded colleagues
• Greater personal investment in the direction of a business
However , private practice can also come with challenges like :
• Startup costs , financial risk
• Learning new business skills
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