Surviving as a Solo Practitioner

Medical practice is never easy. With increasing operating costs, reductions in reimbursement, and the need to implement and maintain an EHR, physicians striving to maintain a traditional solo or small group practice are becoming a dwindling minority. As a result of these pressures, many physicians are choosing to abandon their practices for new business models, either joining larger medical groups that are able to more effectively manage their growing costs or becoming employees within their local hospital systems. The writing has been on the wall for some time that the days of solo or small group practice are numbered.

The benefits of solo practice are well recognized. These include the ability to:

  • Make your own policy and financial decisions about how you want to run your practice
  • Spend as much time as you feel is appropriate with your patients
  • Create stronger, more personal bonds with patients
  • Employ the staff of your choosing and control your own schedule

In 2012, in the face of financial, administrative, and oversight pressures, can a solo practitioner survive? If so, what strategies should be considered in order to do so?

The answer is yes, but physicians wanting to retain their independence and continue to practice solo need to be creative in order for their practices to remain viable. Some suggested strategies include the following:

  • Take advantage of the EHR incentive program and implement an EHR that is appropriate for your practice setting. In small practices, ASP- or cloud-based EHRs are a good choice as they do not require a local server or expensive hardware. Frequently these EHRs will run on low cost desktops or tablets as most of the intensive computing takes place in the cloud. Backups are also handled centrally by the vendor, reducing the need to keep local copies of data in case a server fails. However, do your research and review the EHR ratings on AmericanEHR Partners, including the Top 10 Ratings by practice size (remembering to apply filters for practices of 1–3 or 4–10 physicians).
  • Set up a micropractice. Even the overhead of a relatively small office (if one has to include staffing costs, waiting room, supplies and utilities) can be difficult to cover in a low volume/high care setting. The micropractice is a bare bones alternative without a receptionist or staff and sufficient space to provide privacy while serving as both office and consultation room. In a micropractice, the physician manages every aspect from scheduling patients to practice administation, ordering tests, and dealing with reimbursement. While this may sound daunting to some, the advantage provided by low overhead is the ability to see fewer patients and spend more time in consultation. Physicians in micropractices with a 20–30% overhead only have to see half the number of patients in comparison to colleagues in a more traditional solo or small group practice, which can run overheads of 50% or higher.
  • A concierge practice is another viable option. Patients are charged an annual fee to belong to the practice. As a result, a physician can care for a smaller number of patients and provide a concierge level of care with the annual fee offsetting associated reductions in revenue. For example, a concierge practice of 500 patients in which each patient pays an annual fee of $300 generates a baseline revenue of $150,000/yr. Some physicians are integrating remote consultations, tele-consults, and using other tools such as text messaging to provide a level of care that differentiates them from a more traditional family practice.

A useful white paper was released by the Physicians Foundation in April 2012 titled, Survival of the Fittest: A Review of Promising Models for the Maintenance of Independent Private Medical Practice. Click here for more information.


2 responses to "Surviving as a Solo Practitioner"
  • December 8, 2012
    Randall Oates, M.D.

    Doctors wanting to remain independent will be those learning how to work smarter and not harder. I have been in dozens of 1-2 doc practices where physicians have used a new generation EHR and workflow changes to recover 2-3 hours daily of wasted time to either see more patients or go home earlier (usually a balance of both) and delegate the capture of the necessary structured data in order to participate in initiatives focused on quality measures, etc. Some are going home 2-3 hours earlier and others have increased their income by more than 6 figures. In most of these, there is far less physician work than when they were on paper/dictation and the satisfaction of patients, doctors, and staff are way up. It is possible to thrive even in the current and emerging environments while remaining independent.

    While the micropractice/concierge approach will be attractive to around 20-30% of physicians and 10-20% of patients, it will not be able to scale to serve the masses. This style of practice will be limited due to the inherently exorbitant costs/wastes for most. Most patients are simply not going to be willing to pay doctors wages to have someone doing clerical and administrative tasks. However, doctors satisfied with micro-incomes can enjoy a greater degree of independence for a while within these models.

  • August 13, 2013
    Robin Dickinson MD

    I agree that appropriate use of technology is key to making solo practice successful going into the future.

    I can say from personal experience that “concierge” style micropractice can be extraordinarily affordable for patients. I am currently recovering from a medical set back and only able to work 10 hours a week…however this is enough to support my family. I expect that as I am able to increase to more normal hours, I will not be experiencing the “micro-income” that Dr. Oates mentions in his comment. I absolutely rely on technology to make this work, but with an EHR, patient portal and online scheduling, electronic fax, etc, I am able to simultaneously “serve the masses” and enjoy a comfortable hourly wage.

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