Traditional private practice needs to change


Owning a business is not some pie in the sky deal where you take a phone call when you make the turn at the country club every day. The public at large, however, thinks that is exactly what business owners do.

Owners are the people that collect money while others work right? They are rich people that just happened to be rich, so they bought a business for other people to make them more money. How spoiled!

In reality, business ownership is one of the toughest jobs there is. You are ultimately responsible for not only the financial well-being of your family but all of the employees that work for you. Your decisions shape the lives of everyone. There aren’t many jobs with that kind of pressure.

In medicine, however, we don’t seem to have grasped the time demands and complexities of business ownership. Traditionally, business owners spend their time building their business. While they may be responsible for everything at the beginning, the day to day tasks are gradually handed off as the business grows.

Ultimately, the job of a business owner becomes less about seeing all the patients, and it becomes more about managing systems. Successful business owners are able to make this transition, and in turn, they spent their time working on their business rather than in their business.

When viewed through this lens, traditional private practice starts to make little sense. Physicians not only have all of the responsibilities of a business owner, but they are also the main economic engine within the office. If the physician gets sick or goes on vacation, revenue stops. No sane business owner would tolerate this.

So in a time where physicians are desperately trying to find their voices and maintain their independence, how should we structure private practices to succeed long term? Here are my ideas:

Use non-physician providers better

I have heard many physicians lament the expanded use of non-physician providers (NPPs) in medicine, especially in regards to ensuring mid levels can practice with appropriate oversight. My response to this is always the same. If we want to use NPPs appropriately to provide care, then we, as physicians, must provide leadership.

Think about your state’s regulations. How many NPPs can you supervise? Five? Six? Start hiring as many as you can afford. Have the mid levels provide the majority of day to day care with you available as needed for certain complex patients. Train your staff extensively so they can have appropriate supervision and make decisions within their scope. Training NPPs well to provide good care doesn’t diminish your role as a physician, it amplifies it!

From a business perspective, this decision produces immediate gains. Your revenue streams are diversified. You can afford to be sick or go on vacation. Patients are still being seen, and money is coming in. You can devote more time during your day to evaluating and running your business while still remaining connected to patients.

Decide your path

Some people simply do not want to run a business. They signed up to see patients, not look at balance sheets. No problem. There is no shame in this, and honestly, we need more physicians to evaluate their life goals and pursue their passions.

The most important step, though, is the first one. Evaluate what you want to do. Do you really want to run a business? When you wake up in the morning, do you dream about expanding your practice or do you think about the patients you’re going to see?

Healthcare sorely needs physician leadership in both areas. If you want no part of running a business, then don’t. Don’t open your own practice. Work for someone else, and focus on what you enjoy.

Conversely, I have met many physicians with great business ideas that are slogging through full clinic schedules in a hospital owned network. Stop it! Get out there! Start your own practice. Go after your dreams and provide great working environments for other physicians. We all win when this happens.

Expand your reach

Would you rather be the guy earning $100,000 from one source or $100,000 from ten different sources? Most business owners would pick ten different sources. When you have revenue coming in from multiple places, you can afford to lose one and still pay the bills. If your revenue is all from one place, then your business is toast if that money dries up.

Traditionally, private practices serve their local community. While there is much pride associated with this, physicians are bound to serving only those patients that can physically get to their office.

With the advent of telemedicine, this paradigm needs to change. Many telemedicine platforms exist now. Physicians can either join an established telemedicine platform with patients ready to be seen or start their own telemedicine practice. You can transform your practice from a local business to a statewide one. Start getting licensed in other states or hire people already licensed in other states, and you can take your practice across the nation!

In addition to diversified patient care opportunities, there are many other revenue sources outside of standard patient care. Do you collect email addresses from your patients? If so, you have an entire list of people available to market your expertise to! Many businesses would pay top dollar to have a list like this. Quit complaining that all of your patients are reading crazy health books that you disagree with. Send them quarterly newsletters, maybe even with some paid advertisements, with suggestions for reputable health books you recommend. You can earn some extra revenue and improve both your sanity and your patients’ health at the same time.

It is my sincere hope that more physicians will start to take better advantage of some of these opportunities available to them. Medicine is in dire need of physician leadership so we can let the business of medicine work for us, and not the other way around. Don’t continue to slog away doing the same old thing while your returns continue to diminish. The time for innovation and change is now, and physicians must lead!

“TheBossMD” writes at his self-titled website, TheBossMD. He can also be reached on Twitter, @_thebossmd.

Image credit:


View 28 Comments >

Most Popular

✓ Join 150,000+ subscribers 
✓ Get KevinMD's 5 most popular stories
Subscribe. It's free.