Choosing a Business Model: Solo Practice

Ryan Syrek, MA; Sandy Brown, MD

Disclosures

June 09, 2016

Medscape: What do you see as the challenges inherent to this approach?

Dr Brown: Once you overcome the fear of going broke, there are few challenges. A saving grace of solo primary care practice is that there are minimal expenditures for equipment compared with specialty practices. A one-physician practice can run with one employee—thus keeping down your payroll, which is your biggest expenditure.

You don't need a fancy medical office building to ply your craft; I bought a four-plex in which the other three units subsidized my rent. Once I had paid off the building, the rents paid my overhead. My furnishing came from yard sales and used furniture stores, and my medical equipment came from retiring physicians. I scored a computerized 12-lead EKG machine, pulmonary function unit, binocular microscope, fiberoptic speculum setup, and liquid nitrogen container for $750 from a doctor who was going out of business. There is no need to buy anything new.

I don't use electronic medical records because I don't share my patients' medical records with other physicians unless they're transferring care—and then we fax them, thus allowing me to maintain eye contact with my patients at all times.

Medscape: What do you see as the future of solo practice?

Dr Brown: Unfortunately, residents-in-training rarely have independent physicians as role models in their programs, and they probably never went to a solo practitioner while growing up. My first doc was the general practitioner who delivered me. He worked out of his home; his enclosed porch was his waiting room, and his daughter was his nurse. My first pediatrician worked out the basement of his house, and his wife was his nurse. My first internist had to find another house for his wife and kids because his home office became too busy for family life.

I didn't see a doctor in a medical clinic until I went to college, and he also was a solo practitioner. Independent practice was in my DNA. I don't think many folks under the age of 30 have ever seen a physician outside of a multiphysician office and have no idea how rewarding this practice model can be. Spend a week in my office, and let me show you how to do it!

Medscape: What advice do you have for physicians considering this approach?

Dr Brown: After 40 years in independent practice, this is what I know: To be a successful solo practitioner, all you need to master is how to work for your office manager when she goes on vacation. That is the business part of your practice. But if you don't want to be bothered and just want to practice medicine, then you should go and work for "the man."

I've tried that, but it conflicts with my entrepreneurial spirit, so I taught myself how to use my office management software to schedule appointments, enter patient demographics, create bills, send electronic claims, do aging reports, print statements, and even send my patients birthday cards. Once you have the confidence to run your business, you won't be intimidated by your medical school debt and will do what doctors have done for centuries—become self-employed. Who couldn't be happy being your own boss? You can do this, and you will wonder why it took you so long. Trust me, I'm a doctor.

Readers wishing to contact Dr Brown may reach him at sbrown@mcn.org

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