American College of Physicians: Internal Medicine — Doctors for Adults ®

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How to survive private practice and have a life

An online extra of ACP Internist, copyright © 2008 by the American College of Physicians.

By Janet Colwell

How do busy physicians in private practice find time for their personal lives? Should small-practice doctors perform procedures to enhance revenues and if so, how do they balance that with seeing patients? What are the pros and cons of partnership? These were some of the many questions posed by young physicians and others during the panel discussion, "Surviving as a young physician in private practice."

Ryan D. Mire, FACP: “At first I felt that I had something to prove as the new kid on the block, but now I ask for help.”


Ryan D. Mire, FACP: “At first I felt that I had something to prove as the new kid on the block, but now I ask for help.”



Perhaps one of the most important rules of thumb is not being afraid to ask questions, said panel moderator Ryan D. Mire, FACP, a general internist in a 63-physician multispecialty practice. "At first I felt that I had something to prove as the new kid on the block," said Dr. Mire, "but now I ask for help. Remember that these are your colleagues and the bottom line for everyone is providing good patient care."

Also keep in mind, said panelist Rex S. Morgan, ACP Member, that medical school prepares physicians to care for patients, not to run a business. Dr. Morgan, a geriatrician in private practice with his wife, said he relies on a strong support staff and hires consultants to advise him on business issues and technology.

Rex S. Morgan, ACP Member (left) and Jennifer A. Jackson, ACP Member


Rex S. Morgan, ACP Member (left) and Jennifer A. Jackson, ACP Member



Jennifer A. Jackson, ACP Member, an internist in a small Kansas community, advised physicians starting out to decide what salary they will accept and then come up with ways to achieve it, such as becoming trained in office-based procedures. "My overhead is high and I can't change that, so I had to hone my skills and increase revenue in other ways," she said.

While low reimbursements and hectic schedules make it difficult to survive in private practice, the three panelists said that, for them, the positives still outweigh the negatives.

"I love being my own boss," said Dr. Morgan, adding that tax breaks can make up for some of the deficiency in reimbursement. Dr. Jackson added that there's no substitute for "owning" her schedule. "I take my kids to school and I meet them at the end of the day," she said.

The panelists offered several other strategies for making private practice work:

  • Hire part-time, mid-level practitioners to take notes during visits so the physician is freed up to move to the next patient and spends less time tending to charts after hours.
  • Learn how to perform office-based procedures, such as echocardiograms, stress tests or skin tag removal, that can add revenue to the practice. But do your homework first: Calculate how many procedures you would have to do per month at the current reimbursement rate to make it worthwhile. If one procedure takes the same time as seeing four patients, for example, it might not make financial sense.
  • Diversify your practice by doing part-time hospice or palliative care or participating in office-based research. Dr. Jackson, for example, oversees physician assistants in the emergency department at the local hospital. "Don't pigeonhole yourself," said Dr. Morgan. "You need to be able to transition your practice if things change over the next five years."
  • Explore potential partnership opportunities but balance the up-front costs against the potential long-term benefits. For example, do partners share revenue from ancillary services and will the extra revenue make up for the cost of partnership? How important is it for you to have decision-making power?

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