Single-minded: 4 physicians' paths to solo practice

If you're tired of group practice and think you can run the show better yourself, going it alone sounds like a good idea. But the transition can provide unexpected difficulties -- and unexpected benefits.

By Larry Stevens, AMNews correspondent. Aug. 5, 2002.

Three years ago, Gordon Moore MD, a family physician practicing in Rochester, N.Y., was showing typical signs of burnout.

He felt like a cog moving from exam room to exam room at his five-doctor practice, never getting to know any of his patients. The paperwork hassles were becoming overwhelming. And to make a bad situation worse, his income was falling. Insurance companies were lowering the fees they would pay for many procedures. His group pressured him to see more patients; then it moved from a guaranteed salary to a percent of revenue, ratcheting up the pressure.

"What I was experiencing was not what I wanted to be a doctor for," he said.

Dr. Moore was able to solve his problem while remaining in medicine -- he left his group and started his own solo practice.

The choice to work alone is certainly not a radical decision. But in the case of Dr. Moore and others, it's not only a business decision, but also one based on temperament. Some physicians who made the transition felt they could do better than their bosses in making the practice more efficient. Others with strong entrepreneurial spirits want full control over their practices so they can hire and fire at will and choose what services to add or remove without putting anything to a vote.

Moving from a group or salaried position to a solo operation, however, is rarely easy. Higher-than-expected startup costs, the need to acquire new patients, snags with insurers and problems with new hires can bog down many efforts. But often physicians who take the plunge discover a relatively unique and satisfying way of practicing medicine. [...]