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Solo Surgical Subspecialty Practice

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  • Solo Surgical Subspecialty Practice

    In this current corporate healthcare environment, how difficult would it be to start up a solo Orthopaedic surgical subspecialty practice? Is it basically an impossibility in this age? How have some of you been successful? Thanks
    Last edited by Greenturtle; 03-08-2020, 07:17 PM.

  • #2
    https://www.whitecoatinvestor.com/me...ctice-startup/

    You might be interested in the article. The authors and the comments seem receptive to contact as well.
    I am sure each subspecialty is unique in building , but also in a sustainable business model. If you share your subspecialty, you might get better advice.

    Comment


    • #3
      Originally posted by Tim View Post
      https://www.whitecoatinvestor.com/me...ctice-startup/

      You might be interested in the article. The authors and the comments seem receptive to contact as well.
      I am sure each subspecialty is unique in building , but also in a sustainable business model. If you share your subspecialty, you might get better advice.
      Orthopaedic..thanks for thr link

      Comment


      • #4
        When you finish residency you aren’t an Orthopaedic Surgeon yet, you still have your ABOS boards.
        Part 1 is the summer after graduation. You won’t be practicing until you pass that.
        Part 2 is two years later after going through the collection period.

        Learning to practice (even after fellowship) as an attending , involves a very real learning curve and repetition. That alone is basically a full time job. Every case in the collection period is logged and you want every one perfect and as many as possible and meet the 20 month requirements.
        Trying to build a practice on your own would be a huge distraction.

        Priorities are to get board certified that opens up the physician to compete. Most if not all choose employment (private group or academic) at least until boards are done 3 years out. Employed positions require you to be board eligible.

        Solo practice will be very difficult to compete and sustain without partners in any metropolitan area, too much competition. It is possible to find a location that is large enough to provide the volumes you need or possibly splitting between to midsize to small cities.
        Definitely discuss with Residency Director before you get too far along.

        Suggestion by default is get your boards out of the way before trying solo.

        My view is based upon an observing the process of an ortho with dual fellowships navigate the same choices. Others may have better inputs or suggestions.
        https://www.abos.org/certification/part-ii/
        Good luck with your journey.

        Comment


        • #5
          Originally posted by Tim View Post
          When you finish residency you aren’t an Orthopaedic Surgeon yet, you still have your ABOS boards.
          Part 1 is the summer after graduation. You won’t be practicing until you pass that.
          Part 2 is two years later after going through the collection period.

          Learning to practice (even after fellowship) as an attending , involves a very real learning curve and repetition. That alone is basically a full time job. Every case in the collection period is logged and you want every one perfect and as many as possible and meet the 20 month requirements.
          Trying to build a practice on your own would be a huge distraction.

          Priorities are to get board certified that opens up the physician to compete. Most if not all choose employment (private group or academic) at least until boards are done 3 years out. Employed positions require you to be board eligible.

          Solo practice will be very difficult to compete and sustain without partners in any metropolitan area, too much competition. It is possible to find a location that is large enough to provide the volumes you need or possibly splitting between to midsize to small cities.
          Definitely discuss with Residency Director before you get too far along.

          Suggestion by default is get your boards out of the way before trying solo.

          My view is based upon an observing the process of an ortho with dual fellowships navigate the same choices. Others may have better inputs or suggestions.
          https://www.abos.org/certification/part-ii/
          Good luck with your journey.
          Thank you, I apologize I should have given more info in post. I am 10 years post fellowship, however I am in my 7th year of MOC recert which does have a case collection as well. Was trying to see if anyone had made it work without being academic or coporate which is killing small practices. Thank you.

          Comment


          • #6
            That said, I have “heard of” solo’s in places like Tyler, Tx or Corpus Christi. Would you bring in a partner or how would you handle splitting call? Just curious. One other was approached by a hospital that “needed” ortho coverage, set up PP with a built in feeder. 1099 contract.

            Comment


            • #7
              Originally posted by Tim View Post
              That said, I have “heard of” solo’s in places like Tyler, Tx or Corpus Christi. Would you bring in a partner or how would you handle splitting call? Just curious. One other was approached by a hospital that “needed” ortho coverage, set up PP with a built in feeder. 1099 contract.
              I have potential to bring in 2 partners, but one is board eligible and I have encouraged him to stay put and get past Boards. Other is nonop ortho spine, older near retirement but well connected in community....none of us have to take ER call, employed trauma team at hospital takes all the call. C
              2 different corporations control all 7 hospitals in the area.

              Comment


              • #8
                So you really need to solve two problems.
                Can you build the volume?
                Can you get adequate insurance reimbursement ?
                And do you have the cash for the startup.
                Sounds easy! That is sarcasm, make no mistake.
                I would be curious if you decide to do a business plan and how the hospital corps deal with pp.

                Comment


                • #9
                  Originally posted by Tim View Post
                  So you really need to solve two problems.
                  Can you build the volume?
                  Can you get adequate insurance reimbursement ?
                  And do you have the cash for the startup.
                  Sounds easy! That is sarcasm, make no mistake.
                  I would be curious if you decide to do a business plan and how the hospital corps deal with pp.
                  Yes I was trying to see if anyone on here had done it and how they managed in the beginning, tips tricks etc. The corporations shockingly are very supportive (non financially) of private practice. They market talks and community events for some because they still operate at the big facilities and feed the system. There is not a coordinated private ortho practice within vicinity only 1 or 2 solo guys that are struggling.

                  Comment


                  • #10
                    “because they still operate at the big facilities and feed the system.”
                    Way out of my wheelhouse. The answer is buried in the system of reimbursement, the 3 components being physician wRVU, practice RVU, and malpractice RVU.
                    With Stark kickback stuff, it seems a PP benefits greatly cutting the hospital out using ASC’s.
                    That “practice RVU” is tied to the procedures and feeds the beast. Of course the corporations are supportive. One technique was physicians get an ownership share of hospital or ASC. Hospital owns 51%, and the physicians get their own wRVU’s plus a share of the facility. Not helpful for 3 person group. That’s why the production based contracts exist. Apologies for the musings. Maybe you find a practice consultant the has expertise. I am sure the two hospitals have the numbers.

                    https://www.kareo.com/blog/article/r...ians-need-know

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