Going into my final few months of residency, I am somewhat puzzled knowing that so many of my colleagues are signing contracts with hospital-owned outpatient practices or are going into subspecialist fellowship training or have plans to work as a hospitalist. As someone who plans to go into solo private practice, I feel like an outlier.
Yes, I know what you might be thinking. Who goes into solo practice these days when hospitals are buying up practices, big multi-specialty groups seem like the way of the future, and patient-centered medical homes are right around the corner?
And let’s not forget about my student loans, which total about $250,000. Plus with stricter regulations, the odds are against me when it comes to getting a bank loan to open a practice. From the outside, it sounds like a real hassle to open and maintain an office rather than to go to work for a hospital, get a paycheck, and go home with no worries in sight.
Why not follow the masses and become employed rather than face the risks associated with private practice? For me the bottom line is that in a community that is screaming for more doctors — and primary care physicians in particular — we simply aren’t doing enough to encourage our residents to go to private practice and provide the much-needed care.
Yes, hospital owned outpatient practices are out there — but they don’t have the same continuity of care with their patients since they are employees of the hospital. Not to mention the patient will get a bigger bill because of the facility fee that the patient is being charged since the hospital owns the outpatient practice. So now patients pay more for procedures while this would not be the case in private solo practice.
A lot of my colleagues entered their residency program with the goal of going into outpatient medicine in a private practice setting. But by the time graduation came along, things changed. My colleagues tell me they are looking for job security. They want help to repay their loans. They want a flexible work schedule. And they “don’t really want to get into the business side of medicine.
So why, again, would I consider private practice? An older physician would probably point out that there was a time when opening a solo private practice was the norm when they completed their residency. They would also note that they could get a bank loan without much trouble. Keep in mind, too, that these are the same physicians who are training and teaching today’s residents. I believe that today’s residents have a different mindset for some of the aforementioned, and important, reasons: They are concerned about the debt they have accumulated. They are concerned the risks associated with running a business. And they are concerned about medical malpractice.
I truly appreciate those concerns. Yet I also believe that we must find a way to change the cultural mindset within the medical profession to preserve the private practice model if we hope to facilitate the continuity of care and to have a better patient-physician relationship and to decrease health expenditures for our patients. Furthermore, we need to provide our physicians with the autonomy of running their own business with support and not despair.
At least that’s why I have decided to go into private practice — and I hope that I’m not alone in that regard.
Eddie Fatakhov is an internal medicine resident.