would you do it? (start up a solo practice)

Home Practice Management would you do it? (start up a solo practice)

  • Avatar s2km 
    Status: Physician
    Posts: 39
    Joined: 01/12/2016

    In a prior thread I was seeking advice about a partnership offer that wasn’t too fair.  It seems there is no compromise or terms we can agree upon (and also I have lost trust), so I am either going to look for another practice with a defined partnership track or open up my own practice.  I’m in a surgical sub-specialty, ~5 years out of residency.  Plan on keeping things simple and small. Overhead as low as possible, 1-2 staff.  Have a good reputation in the area.  Pretty much have the general plan in mind already (name, location, EMR, workflows, etc).


    – Everything will be customized to my liking, I’ll be in charge.

    – There is a need in the area.  Throughout last year there were about 6-8 openings around the region both hospital and private practice.

    – There is a retiring doc I have been be loosely keeping in contact and he has been encouraging me to go to solo. He is retiring in 1.5 years time and has said he would just refer all his patients to me if I ever go out on my own. He already refers his surgical patients. I do not want to buy his practice as his office location is in a run down area and really outdated/old – I would just have to start over anyways.


    – big risk…going from stable-ish income to not stable at all

    – uncertainty of insurance/healthcare – declining reimbursements, going from fee-for-service to whatever

    – challenges of owning and running a practice (although I feel like I would embrace it as it’s my own thing)

    I’m motivated and have that entrepreneurial drive to make it succeed…I mean I would have to – there would be no other option. Other practices are doing it now…why wouldn’t I be able to as well?  Then again, I also think…am I an idiot for giving up my current situation to take that risk? If you had the capital and decent working knowledge of how to run a practice, would you take the risk and start your own solo practice these days?

    Appreciate the input – Thank you!

    #179190 Reply
    Avatar SValleyMD 
    Status: Physician
    Posts: 414
    Joined: 05/12/2016

    Go for it

    I’m not a numbers guy so I can’t help u there but great thing about medicine is you’re most likely competing against a bunch of social rejects or a bunch of disenfranchised employeed docs that couldn’t care less about growing a practice

    Personally I think now is the time for energetic, motivated docs to figure out a way to take advantage of the current climate. Seems like anyone motivated can create volume. Somehow that has to pay off I would think.

    I’m starting to think there is nothing worse than being a cog in the machine. Maybe it’s me staring at another week of punching the clock for the man so I tip my hat to you if u have the guts to do it.

    #179195 Reply
    CordMcNally CordMcNally 
    Status: Physician
    Posts: 2255
    Joined: 01/03/2017

    I think you should go for it, too. Being your own boss is worth A LOT. If it doesn’t work out, it sounds like you’ll have some other options for a steady paycheck.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #179230 Reply
    jfoxcpacfp jfoxcpacfp 
    Status: Financial Advisor, Accountant, Small Business Owner
    Posts: 7511
    Joined: 01/09/2016
    Splash Refinancing Bonus

    Add my aye to the thumbs-up crowd. Be sure not to short yourself on a qualified, experienced financial advisor/CPA.

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    #179261 Reply
    SerrateAndDominate SerrateAndDominate 
    Status: Physician
    Posts: 401
    Joined: 02/01/2018

    Sounds like you’ve put a lot of thought into it already. With that many openings in the area, it definitely sounds like there is a demand. Props if you make the jump.  That’s bold but seems like odds tilt in your favor based on your research.  Let us know which way you go

    Earn everything.

    #179262 Reply
    Avatar G 
    Status: Physician, Small Business Owner
    Posts: 1546
    Joined: 01/08/2016

    Go for it. It sounds like you dont have a constitution that would thrive as an employee, so you might as well start running the show now as opposed to later. My only concern/question would be about covering call for your established patients.

    To be fair, you are asking on a financial forum…kinda like asking what is the best type of wine at a Sonoma Pinot convention.

    #179270 Reply
    Avatar Kamban 
    Status: Physician
    Posts: 2257
    Joined: 08/01/2016

    I have told my story here too many times. Being strung along by a sole owner of a multispeciality group for 7 years post fellowship with no partnership in sight.

    Decided to start paying in for expenses and rented space and furniture / utilities from him. Accumulated money to start on my own should he not be satisfied with the arrangement. Six months later he was demanding an outrageous money to stay. I declined it and he kicked me out. Within the one month notice period I started on my own and used my savings to start and pay for my employees until the checks started to roll in 6 weeks later ( had to buy computers and new billing software).

    I would never go back to being employed. After a few years of good income it is down due to hospitals cornering the market, the insurance paying far less for a person with no clout and the cost of doing business for one person versus 3-5 in a group. If you can take care of the first 2 issues you will earn as much as being employed with much much better happiness and satisfaction. Invest aggressively early on so that later on you can work at your own pace without worrying about what you bring in that month / year.


    #179298 Reply
    Avatar s2km 
    Status: Physician
    Posts: 39
    Joined: 01/12/2016

    Thanks for the input so far.  I do think the demand is there, especially with that retiring doc who says he would refer to me.  The owner of the practice I’m at has been wanting to retire for so many years.  Another older 2 person practice is just doing like part time and no more surgeries.  I figure I have 25+ years ahead and time on my side to outlast them and establish myself. There is a big hospital/healthcare group that has some younger employed docs, but I am also currently within their network.  There is another University healthcare group but they do not have my specialty in the hospital in my area…yet.  I was thinking about working something out with them to kind of fill that need so they don’t expand themselves.

    @kamban – That is a similar situation and I have also been saving myself for that scenario.  Glad it has worked out for you.

    The biggest thing I worry about, which is pretty much what every practice worries about, is getting the billing right – collecting from insurances, appealing denials, and how best to collect balances from patients.

    Signs are pointing towards making the leap. Will keep you updated if it happens.

    #179473 Reply
    nachos31 nachos31 
    Status: Physician
    Posts: 421
    Joined: 01/12/2016

    I’m a newbie (in year 3) employed primary care doc and have a good thing going currently even with the constant chipping away of money/autonomy/our souls all docs are experiencing. That being said I have the general workings of a back-up plan. If things turn south or reach a critical point and I end up leaving my current gig, then I’d try my hand at starting a solo direct primary care practice. In fact, I’d be working on the transition right now if I didn’t like my current job so much.

    All that to say: go for it. I’m not sure about a solo direct care model for a surgical subspeciality but worth looking around. Keith Smith’s Surgery Center of Oklahoma has done some amazing things but that’s a much larger enterprise than what you’re looking at.

    Out of curiosity, which EMR would you choose?

    Best of luck!

    #179487 Reply
    Avatar Good Life 
    Status: Physician
    Posts: 32
    Joined: 05/25/2017

    I’d say go for it!  And this is from someone (surgical sub-specialist) who has just left his partner (we were a 2 person practice) also due to a bad situation with an older partner.  The only difference is, I’m in a very saturated market and am not sure I can make it alone, so I ended up joining a hospital group instead. I didn’t have any other appealing group options, so employment here I come.  Had I been in a not saturated market like yours, I would have tried to give it a go solo.  One thing you can try with billing if it is too much for you is to outsource billing. I know they take a cut (usually 4-5% of collections), but if you find yourself struggling with billing and hating it you can go that route. The EMR we used was tied into our practice management system, and their clearinghouse they contracted with offered to completely outsource billing. Sounded like it would relieve some of that headache, albeit for a big chunk of change.

    #179489 Reply
    Avatar s2km 
    Status: Physician
    Posts: 39
    Joined: 01/12/2016

    As far as EMR, leaning towards a specialty specific one that has PM/revenue management integrated and a portal. I would want to try to keep billing in house…planning on having my spouse do it…some learning curve but I don’t think an outside company would go after claims and balances better.

    #179773 Reply
    Avatar jacoavlu 
    Status: Physician, Small Business Owner
    Posts: 1998
    Joined: 03/01/2018

    We outsource billing. I like when interests are aligned. The more they collect, the more they get paid.

    The Finance Buff's solo 401k contribution spreadsheet:

    #179780 Reply
    Liked by Tim
    White.Beard.Doc White.Beard.Doc 
    Status: Physician
    Posts: 786
    Joined: 02/06/2016

    One big challenge of going solo is dealing with the insurance companies.

    The large multi-specialty groups in my area have the market share to command good reimbursement rates from the insurance companies.  The small solo practices have to take whatever lousy rates they can get.  And some of the insurance companies have closed panels in certain specialities so that the answer is a simple no, no prior approval and no reimbursement as you are not on the panel.

    So going solo can work out well if you have a good payor mix and can get reasonable rates from the insurance companies for your work.  Do you have the information you need about insurance reimbursement to make the right decision?

    #179805 Reply
    Liked by Tim
    Avatar snowcanyon 
    Status: Physician
    Posts: 434
    Joined: 10/22/2018

    More power to you. Why I picked EM I’ll never know 🙁

    #179806 Reply
    Liked by Tim
    Avatar mxg67 
    Status: Physician
    Posts: 78
    Joined: 11/25/2016

    As far as EMR, leaning towards a specialty specific one that has PM/revenue management integrated and a portal. I would want to try to keep billing in house…planning on having my spouse do it…some learning curve but I don’t think an outside company would go after claims and balances better.

    Click to expand…

    I think that’s a good way to go, no one cares about your money more than you (and your spouse).  I’ve heard from a few solo PP docs that had better results when their spouses started doing the billing.  I too considered a solo PP gig, but in my specialty (cardiology) it’s an uphill battle, and all the PP docs in my preferred area said don’t do it.  However, you situation sounds ripe for picking. I know a few solo PP surgical subspecialists doing well and they seem to have an easier go of it compared to other specialties.  Low overhead and spousal help is the way I’d go too.  I think you’ll do great.

    #179819 Reply
    Liked by Tim

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