Choosing a Business Model: Solo Practice

Ryan Syrek, MA; Sandy Brown, MD


June 09, 2016

Editor's Note:
From young physicians considering their first practice model to experienced doctors contemplating a change, the advantages and disadvantages of a new situation can be overwhelming. For this fourth installment in a series examining various business models for physicians, we asked Sandy Brown, MD, to give us his perspective on the ins and outs of a solo practice model.

Medscape: Could you describe the basics of the solo practice model?

Dr Brown: The basics of working in a solo practice are essentially the same as working in a concierge practice, except that you don't charge a membership fee that effectively excludes patients without the ability to pay. And you don't have patients pay twice for the same service, because they already are paying health insurance premiums that presumably cover their office visits.

Of course, some of the services that concierge doctors provide, you do for free—for example, promptly returning phone calls, offering same-day appointments, and perhaps even listing your telephone number in the phone directory—because that's just what caring doctors do.

Because you are not sharing your income with health plan managers, medical billers, and other extraneous-to-patient-care administrative staff, you get to keep the whole pie; that, coupled with learning how to keep your overhead low, means you can see as many or as few patients as you like and still make a good living. And you won't have to think about whether you would have gotten into medical school if you had told your medical school interviewer that you had a two-tiered medical practice system in mind, in which your patients' ability to pay influenced the care they received.

Medscape: What are the advantages that led you to practice in this setting?

Dr Brown: Many. The primary advantage is that you will have a thousand bosses and not just one, because the only real job security in today's medical marketplace is our patients. One mismatched doctor/patient relationship still leaves you with 999 matches—but a mismatch between you and your CEO or supervisory physician could leave you looking for a job.

Second, you may hang whatever pictures you like in your office without anyone saying you're tacky. In other words, you can make your work space your own, and you won't need a committee to approve your decor. If you're spending more than 40 hours per week at your job, don't you want to be comfortable?

Third, your staff will have no one else to be loyal to. People are loyal to whoever pays them. If an HMO or hospital is paying your overhead, your staff's first allegiance will be to them. Pay your staff yourself, and they will work hard to make you happy and successful in your healing art.

Fourth, you can come and go as you like. If you want to be a workaholic, no one will stop you. Or if you want to work just 3 days a week (as I do), you can do that too.

Fifth, you won't have to attend meetings about how to improve your efficiency and see six patients per hour. In fact, you won't have to attend meetings, period. You can decide for yourself how to balance efficiency and quality.

Sixth, you will be the boss. You won't have to follow policies and procedures created by someone with a business degree who knows nothing about medicine. There may be a lot we can learn from businesspeople, but no one can understand your patients and your practice better than you.

Seventh, you will have fun. The practice of medicine can be extremely satisfying when you get to create the kind of culture you want. Besides, if you can't have fun in a practice where things are just the way you want them, then how can you?

Eighth, you will be rich. Learn to run your practice right, and you will be rich enough to pay back your student loans and satisfy the requirements of your imagination.

Finally, you will be preserving an endangered species: the independent physician. Our extinction would be an unfortunate loss for the healthcare ecosystem.