The Joys of Private Medical Practice

by Hilliard Slavick, M.D.

Psst, want to know a secret? Running a private medical practice can bring terrific financial and personal rewards.

There, I said it, knowing full well that many in the medical community may now suspect I need to have my head examined.

The travails of operating a private practice are known all too well, and I will touch on some of them momentarily. But there are very real benefits, too.

At my practice, Clinical Neurosciences, we foster an environment of personalized care and independently provided advice. Being in charge means being a maverick, able to choose where you want to work and what you want to do without a department chairmanís approval.

So, opportunities abound to take on fascinating cases. Granted, you also take on some added inconvenience to your lifestyle: it takes a committed person to devote himself to the care of others beyond the world of 9-to-5. But a private practice retains its humanity, passion and relationship with clients.

The real joy of a private practice is seeing patients every day, meeting people and getting to know their conditions and personalities. As the tension between patients and insurance companies increases, it is important for individuals to know that their practitioner is giving independent advice regardless of external pressures.

They will learn to trust your opinion even more if the bond is stronger than a typical doctor-patient relationship. This connection with my patients has kept me motivated to strive for improvement, and is the reason I have stayed in private practice for 30 years.

The journey has had its challenges. For example, though I prefer to have three or four fellow neurologists on staff with me, for the past eight years Iíve only had two. And this summer, that number fell to one.

Itís becoming increasingly tough for private practices to attract, and retain, quality physicians.

Undoubtedly, the economic development of the HMOs in the 1980s has played a major role in this evolution.

The emergence of HMOs prompted private practices like my own to sign contracts with them or face a significant loss in client numbers. While the HMOs help to provide a steady influx of patient referrals, it has also been coupled with decreasing insurance reimbursements, higher risk insurance costs and tension with patients over coverage and treatment discrepancies.

Another significant factor that Iíve detected is an increasingly short-term mentality among young doctors who are more likely to join large group practices or university hospitals, focusing on subspecialties, rather than devoting time to a private practice.

Jumping to a larger practice group or a university might initially increase a young doctorís salary or seem like a more stable option. But the downside to universities is their focus on teaching and research, dedicated more to scholarly work than treatment of patients.

I have seen the benefits to those in private practice who display dedication to their profession, as well as to forming relationships with patients, colleagues and staff.

Devoted mentors can make sizeable contributions to a young physicianís development and in a private practice one physicianís improvement sparks more satisfied patients and increased client referrals.

My first job after medical school was in a private practice where senior doctors took the time to mentor me. I improved not only my technical skills, but also learned the business tools from those doctors who had already navigated that road.

Though some may argue the way has become overrun with potholes and cracks, there is still a road map for one heck of a joy ride.