If you are a physician in a hospital employment relationship and are seriously considering establishing or reestablishing a private practice, you should begin by recognizing that this will not be your father’s practice. The world has changed, and reestablishing what you had probably is not the way to go.
Where do you start?
Look at this as a fresh start. Look at it as an opportunity to create something totally new and different—as a way to avoid being a prisoner of your past experiences. So, the first step is to carefully consider the vision of what you want your practice to be. That vision can be guided by questions such as these:
• Do I want to be in solo practice?
• If not, who will I practice with? Who will my partners and associates be?
• What about a small group?
• What about joining an existing independent group? • Single-specialty or multispecialty?
• Are there others as miserable as me and will anyone want to do this together?
• Who will I share call with?
• Should I look at alternative practice models such as a concierge practice?
• Will the hospital compete with me?
• What are the terms of my contract with the hospital and can I get out of it?
• Do I have a noncompete?
• Will I be able to get payors to contract with me?
• Who will be my office manager and key staff? • Where will I find key staff and what will they cost?
• What benefits will my staff want and what will that cost?
• How will I do billing and collections?
• What about electronic health records and other technology?
• How much will it cost to get started? Where will I get the money?
• What if the money doesn’t come in?
• Can I get financing? Where? How? At what cost?
• What will my income be?
• Will I have to go without income for a while? How long?
• Where will my practice be located?
• Should I own my own building?
• What about furniture and equipment? What will I need? What will it cost? Where will I get it?
• Who will be my trusted advisors: attorney, CPA, and practice consultant?
• Will my patients follow me?
Answering these questions and the many others that come up will take some time, thought, and effort. Obviously not all of these questions will apply to everyone, and some of the answers may be obvious to you while others are more troublesome. Some questions may be unanswerable. However, the important question to ask at this stage is this: What did I like and dislike about private practice before, and what will I do differently this time?
President, Delta Health Care
Excerpted from: Choosing Autonomy: The Physician’s Guide to Returning to Private Practice, by Randy Bauman