As a medical specialist, one of the biggest decisions you will face coming out of your fellowship is whether to start your own solo practice or to join an established multi-physician group practice. We will go through the pros and cons of each, and at the end, I will give you my mostly unbiased opinion on what works best for most new grads. To set the stage, solo practices are much less common; according to the CMA in 2017, only 21% of Cardiologists and 19% of Respirologists ran one.
Starting a Solo Medical Practice
Pros:
Autonomy and Flexibility: You have complete control over your practice, including setting the hours, hiring and firing staff, selecting an EMR, buying equipment and choosing the policies and procedures of your office. You don’t have to consult with anyone to change the culture or infrastructure of your clinic. This means that you can build your practice around your preferences and be flexible enough to adapt to changes quickly.
Personal Branding: As a solo practitioner, you establish your own personal reputation in the community. If this goes well, you can develop a loyal referral and patient base who specifically seek your care.
Financial Independence: The buck stops with you, on many levels. You keep 100% of the gross revenue generated by your practice.
Cons:
Higher Initial Investment and Risk: Make no mistake, a medical practice is a small business, and most MDs have no business training whatsoever. You may need to sign a lease, negotiate staff contracts, buy equipment, furniture, insurance, disposables, etc. If you settle in a well-serviced or over-serviced area, it can be difficult to compete with existing group practices for referrals. Having holes in your schedule from lack of referrals is inefficient and can be stressful
Bigger Responsibility and Workload: The solo practitioner shoulders all the responsibilities of running a practice, from patient care to administration to finance. This can be overwhelming and can tip the scales of work-life balance. The average Respirologist spends 1.9 hours per week on practice management (Cardiologist 1.6 hours/week) according to 2019 data from CMA, with more hours being reported by solo practitioners. To quote the CMA 2021 National Physician Health Survey, “High administrative workload and lower satisfaction with work-life integration may be related to low professional fulfillment.” If you are attending a conference or are away on a well-earned vacation, who will take care of your patients? You still must pay your overhead expense when you are away, even though in a fee-for-service model, your income has dropped to zero.
Joining an Existing Group Practice
Pros:
Shared Responsibilities and Resources: Sharing the workload with colleagues means each individual MD spends less time with administrative tasks and financial management, freeing up more time for your actual expertise, patient care. Larger practices are more likely to have an office manager, alleviating even more responsibilities from the practicing physician. Having full professional management may drop your administrative burdens to zero.
Established Referral Base: Group practices, especially the long-standing ones, will have a solid stable of referring physicians, allowing new members to hit the ground running with full schedules.
Collegial Environment: It is hard to work in isolation, both socially and professionally. Being around experienced MDs will allow new grads to gain expertise, or just discuss difficult cases. This also allows opportunities for networking and joining into business ventures that require multiple physicians.
Lower Financial Burden: Relative to stating a solo practice, it generally takes less up-front investment to join an existing group, since office space, equipment and computer systems are already in place. Group practices also enjoy bulk discounts on medical devices and disposables.
Cons:
Less Control: When a new member joins a group, they are expected to follow procedures and policies already in place. This could limit your autonomy over certain aspects of your practice, like scheduling.
Limited Personal Reputation: In general, a new member’s reputation automatically rises (or less likely, falls) to the level of the group’s brand. It may take some time to develop a distinct identity and referral base separate from the rest of the group.
Potential for Office Disputes: While most groups are very collegial, there can be conflict over practice management and revenue sharing. Resolving these issues can be time-consuming and may affect the “feel” of the workplace temporarily.
The choice to start a new solo practice or join an existing group practice must align with your long-term career goals, practice style, and business knowledge. You should weigh the pros and cons, and consult with professionals, mentors, and colleagues. In my opinion, for most new specialty medical grads, joining an established multi-physician practice is the way to go from a financial and work-life balance perspective.
Finding the right existing group practice to join? Maybe that’s something SMP can help you with – feel free to contact us.
Author: Dr. Krishna Sharma, Chief Medical Officer, Specialty Medical Partners
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