Finding Joy in Independent Physician's Practice

Anyone who follows the healthcare industry today most likely has come across at least one report about the decline of physicians going into independent practice and the epidemic of physician burnout and dissatisfaction. Gone are the days when many went into medicine with the expectation of being able to throw up a shingle, not worry about overhead, and play golf every Wednesday afternoon. New residency graduates, saddled with student debt, are instead flocking to jobs at hospitals, partly out of fear due to uncertainty about what lies ahead in healthcare. Once-independent physicians are selling their practices to private equity groups and mega hospital systems because they are fed up with the egregious administrative and economic burdens of running the business.

Some Context

When I entered medical school in the 1990s, things were different. I had never wanted to go into private practice—which made me the outlier. I had always thought that private practice was nice to have as an option—having options was one of the big draws to medicine. But I didn’t think it was for me. I was interested in working in an academic center or larger multispecialty organization where I could provide excellent patient care, teach, and have a leadership role free of what I perceived as the boring details of minding the shop. Like so many doctors, I didn’t go into medicine to worry about coding and time clocks and dealing with vendors.

By the time I completed my training, however, the economic and political environment had changed. Even academic and employed physicians were feeling the pressure to see large volumes of patients in their work places. Doctors worked more and saw their salaries drop. They found themselves having to support growing legions of health administrators who seemed to grow rich as the doctors struggled. After a few years of working at hospitals and not finding a work situation that I saw myself wanting to stay in longterm, I realized that I was going to have to create one. The path to becoming a board-certified dermatologist had been long and at times hard. Now that I had my credentials, I was determined not to let external circumstances take the joy of practice away from me. Ironically, in my case, it was the thing that I never wanted to do—start a private practice—that was one of the best professional decisions of my life.

Independent Practice Perks

Without business experience, training, or a plan, I started a private practice in Manhattan with my personal credit cards. I had no idea how challenging it would be. I also had no idea what a delightful experience it would be. I didn’t have a vision for my business, other than to provide excellent patient care, but I did know how I wanted to feel in whatever setting I worked in during my time on earth. In the process of building the practice I never wanted, I grew both professionally and personally and was in a position to enjoy many of the opportunities I thought I had given up by leaving jobs at larger institutions. Yes, we are in highly disruptive and less certain economic times in healthcare. No, not everyone is suited to the entrepreneur’s life. It’s still possible, however, to have a work and personal life you love through independent physician’s practice. Here are some of the perks.

Freedom to Adjust Your Day to Your Satisfaction. One of the benefits of having one’s own practice is that one can make decisions that work best for her/his life…and business. For example, when I started my practice in New York City, I, like most New Yorkers, used public transportation to get to work—and I wasn’t a fan of rush hour. Sometimes dealing with the crowds drained my energy before the day had started. I had also noticed when I was employed at hospitals that staff who had children had challenges getting to work on time in the morning because of parental responsibilities. Having the authority to set up my practice times to avoid a daily experience that I found unpleasant made me really happy. It turns out, the hours I set up also worked well for my business. By not being on the same work schedule as most of my patients, who were working people, I was able to make myself available to them on their lunch breaks and after work without over-extending myself. My staff had less trouble getting to work on time. This helped make my practice popular more quickly. Further, I always had some time each week to attend to my personal needs during business hours. I always had permission to schedule days off when I needed to. Although I worked full time, I didn’t feel neglected.

Work-life Balance. A common complaint of employed physicians—and people in the modern workforce in general—is that they lack work-life balance. This is particularly true for working parents. What an independent doctor might lack in back-up, they can, however, make up for with flexibility. When I became a mother, having an independent practice was scary; at that time I was the only person bringing income into the business. However, independent practice allowed me to make parenting and working less stressful. Although I controlled the maternity leave policy, and in that respect could take “all the leave I wanted,” I had responsibilities to protect the business for my patients, staff, and self. Ironically, patient loyalty was draining my bank account as people were choosing to wait until I returned instead of seeing the doctors who were kindly covering for me—so I went back to work quickly. I could set the hours to make my business and the rest of my life work. I spent a lot of time with my child when she was a baby and I continued to build my business.

I’ve also seen other colleagues with their own practices and who were new parents take advantage of their independence to have practices and lives they love. Some set up rooms to bring their infants to work as they continued their business through new parenthood. Some independent doctor couples set up the work schedule so that one of them could always be home with their children, yet both continue to work. This type of flexibility may be harder to achieve in larger institutions.

Transparency, Agency, and Efficiency. In larger organizations in which there may be many layers of bureaucracy and administrators, a doctor may become frustrated due to lack of information and power to practice efficiently and make changes. Smaller practices where the doctor stays informed and has authority to make decisions can address problems and execute strategies more efficiently. Feeling empowered increases doctor satisfaction. If an independent doctor gets feedback from a patient, there is more freedom to take action. An independent doctor has more freedom to get staff they work well with and arrange the environment to their needs.

Accelerated Business and Personal Growth

Usually when we hear someone say, “What doesn’t kill you makes you stronger,” it’s because someone is facing some difficulty. Challenges and pain are a part of life, but when you are your own the boss, it doesn’t work to retreat into delegating responsibility to address a problem to an outside power. Running one’s own practice forces you to face things. This often involves an evolution in one’s mindset that can have a positive impact on one’s professional, as well as one’s personal, life.

Dr. Strachan now makes a point to share her accomplishments with patients as a way to highlight her expertise and differentiate, rather than think of it as “bragging.”

People attracted to medicine often are of a mindset that puts them at a disadvantage in business. Early in our careers we are often rewarded for being selfless, appearing humble, and not caring about money. In part this is why we’ve lost so much power in an industry in which we have the most expertise. When employed at a large organization it is hard sometimes to understand and have an impact on “the system.” Employed physicians, although protected from some responsibilities, often express frustration at that lack of transparency with respect to decisions that affect them and their patients regarding operations and their reimbursement.

In one’s own practice, however, one is not protected from having to develop leadership skills. It can seem burdensome after going to medical school and surviving residency to have to then learn something else—finance, human resources, marketing—just to be able to use one’s hard earned skills. It can be humbling, armed with so many credentials, to come to realize that many of the frustrating aspects of being in business were not external but the results of a disempowering mindset.

When I expanded my office in New York City—perhaps the most competitive marketplace in the country—in the middle of the financial crisis of 2008, I became frustrated as I saw more and more people who would come to me, a Harvard and Yale educated, UCSF-trained, board-certified dermatologist, after having first gone to a spa to get help for their skin condition from someone who likely had a high school education. It wasn’t that these people didn’t have access to healthcare. They did. Further, they were often carrying bags full of hundreds of dollars of ineffective products, purchased at the spa, that they wanted me to analyze as they complained about paying their copay.

At that time in my career, I had the old school attitude that “good” doctors didn’t have to market. Patients would recognize quality and would seek it out. I had that traditional doctor mindset of taking pride in being humble. What I started to see, however, was that my mindset was not going to work in this new economy. Many patients didn’t even know what my credentials meant. I also came to realize that my competition was no longer just other dermatologists—it was everyone. Now there were more options to getting skin problems addressed. Challenging economic times led non-dermatologists as well as non-doctors, to explore aesthetic services, and even some medical dermatological services, that had traditionally been the territory of board-certified dermatologists.

I also had to face the humbling reality in the age of digital marketing, online commerce, and social media, that although I had invested in getting the skills and credentials, I would not necessarily be able to compete with less qualified people who had invested mostly in marketing—even if they provided poor outcomes. And when a pharmaceutical representative visiting my office suggested that I hire a public relations firm to get quoted in some magazines I thought of how foolish I was being storing the many magazines I had already been quoted in in a file cabinet, worrying about how it would appear if I were to display my legitimate accomplishments. I began to look at marketing as simply letting people know that I can help them with their problems rather than as bragging. This was growth for me. It was a mindset that was in alignment with my values and great for my practice. It also made me develop a skill set that is valuable in many other areas of my life.

It’s About Mindset

No, being in private practice in today’s healthcare environment is not for everyone, but with a bit of moxie and a growth mindset, it can still be an excellent option.