Medical Practice - Page 7
TYPES OF PRACTICES
In the final year of postgraduate medical
training (unless you are enrolled in the armed
forces), planning ahead for opening a practice
is essential. This involves determining the
location as well as the nature of your practice.
Many considerations are involved in both
issues. They need to be carefully considered
before making a final decision.
Location considerations include not only
personal preferences regarding the type of
community--rural or urban--but also how strong
will be the demand for your services
and for how long. In other words, a pediatrician
obviously would not consider an area
where the predominant population is made up of
retirees. Even if you plan to join an
older physician and ultimately take over his or
her practice, you need to assess the like-
lihood of demand for your services down the
line if the neighborhood changes.
As to the nature of your practice, it is
important to determine if you prefer to start
on your own or work for others. There are
several options in each of three major cate-
gories, solo, group and salaried practice.
These will be explored below.
Solo Practitioners
Solo practitioners currently still remain the
largest group of practicing physicians, but
their numbers are diminishing as the health
care system changes. These physicians have
direct contact with each one of their patients
as the provider of professional services. In
exchange for remuneration they are personally
responsible for their patients' health.
They operate out of their own office or
time-share one with others.
There are several advantages to this
traditional form of practice, particularly for pri-
mary care physicians, internists,
pediatricians, and obstetricians/gynecologists. These
include establishing long-term relationships,
in most cases. (People do move out of the
area or are dissatisfied and select someone
else.) Another consideration is the indepen-
dence that solo practice permits. Solo
practitioners determine the location of their prac-
tice, arrange their office to their liking,
hire the personnel they think they need and who
they want to employ, select the laboratories
that will perform their tests, set their own
office hours, fees, and all the many other
elements associated with a practice. To a large
extent, therefore, they determine the extent of
the success of their own practice.
On the negative side, there is the factor of
uncertainty of how rapidly their practice
will grow and how frequently they will get
referrals from others; consequently, the rate
of growth of their income will be
unpredictable. Initially their income may be less than
that of salaried practitioners whose expenses
are paid for by their employers. Another
major consideration is that solo practitioners
assume full liability for the unavoidable
overhead associated with such a practice.
Another factor is the need to have coverage on
days off or during vacations.
With the marked increase in paperwork required
for Medicare, Medicaid, and insur-
ance reimbursement, an additional heavy burden
and expense has been placed on physi-
cians. This issue adds to the already
restricted autonomy of physicians due to federal,
state, and insurance company regulations that
evaluate the appropriateness of patient
treatment and tests and set guidelines for the
length of hospitalization.
There are a number of variations to solo
practice that try to reduce some of its nega-
tive features. The following are some
examples:
Solo-HMO Practice
Many established solo practitioners seeking to
maintain this form of patient care that
they have long been accustomed to, but
realizing the changing situation in health care
economics, have made a significant adjustment.
They have decided to keep their solo
practice, but at the same time be linked to an
HMO accepting their lower levels of reim-
bursement and making up for it with a large
volume of patients, for each of whom they
receive a monthly stipend, if in a capitated
HMO, or a reduced fee-for-service payment
if in a noncapitated HMO.
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