Dr. L describes starting his solo independent (IMP) practice right out of residency, the joy, headaches and heartaches it gave him - dealing with the burden of administrative and clinical complexity. Dr. M chose to leave private practice and join a group.
Don's advice to Dr. L (below) struck a chord in me. I've spoken to hundreds of docs setting out on their own and figuring things out. We've built a remarkable community on line that provides mutual support and encouragement. Don reminds us that the goal of ideal practice is not to work alone, but to shed the complexity that increases our expense at the expense of the care we would deliver to our patients. Don reminds us that even when we work in solo practices we are part of larger networks.
Most of us are problem solvers at the start and through our training have learned to be self-reliant and proactive. The lessons are usually taught in ways that champion personal effort. Implicit (and sometimes explicit) lessons are taught that team effort is not the way of our profession, that if you didn't do the work yourself you are not worthy. This is a very dysfunctional lesson and belies the reality of our work.
Dr L did not fail in his practice. Our system of health care delivery has failed to support and environment that allowed his practice to succeed. Those fresh out of training should not have to go pay dues in a typical practice before they're able to set up their own. Our society should not tolerate the current group think that solo and small practices should/must fail so that we all deliver care through large vertically integrated delivery systems. While some VISDs (vertically integrated delivery systems) may provide wonderful care not all want to be cared for by large institutions.
As I've written often in the past solo and small practices can delivery very high quality care, are able to measure results and hold themselves to the highest standards. Our nation would do well to back efforts that support solo and small practices in pursuit of excellence, to provide mentoring, measurement tools. Practices that demonstrate excellence should be rewarded by receiving full funding for their work and absolution from the insane burden of administrative trivia.
Don's note to Dr. L:
It sounds like you actually did remarkably well for two years, starting out directly from residency training, with no other experience. I have no doubt that you will do very well at X, and they are very fortunate to have you.
I suspect that if you had a few years of experience in private practice (perhaps working for someone else) before starting your [solo practice], you might have made some different choices, and might have found the IMP experience a little bit easier. Learning practice management is always painful. Having an experienced biller to help you learn does help. You might have made the choice to farm out your billing to a service, had you realized what a pain it is to deal with the insurance companies directly.
Psychotic patients are always difficult. Learning to refer early, and to get someone with whom to share the burden of dealing with them is essential. In fact, learning to deal with those few patients who are are so needy that no one physician can do everything for them is a very important lesson.
When my family was young, I was not a particularly good husband or father, due to my preoccupation with my solo private practice. Being an employee, with more predictable time off, would have helped a great deal in that regard. I consider myself very lucky that the kids turned out as well as they did.
Learning ways to stay in touch with colleagues is critical if one is solo. It is much easier if you are part of a larger practice, but staying active in the local chapters of your professional organizations, serving on hospital staff committees, volunteering at free clinics, and being on listservs are all ways of accomplishing that. Not so easy when you are trying to spend time with your family, however.It sounds like you learned a lot, and made some good choices for what to do now. You will probably effect some very positive changes at X. If, in a few years, it does not seem right for you, you will be in a much better position to decide what to do next.
Donald T Stewart MD
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