Thriving in Private Practice

Becoming your own boss: Transitioning into private practice affiliated with a health system

Jun 30, 2022

In this episode of AMA Thriving in Private Practice, our guest, Sonal Patel, MD, of Magnificent Minds Neurology Center, shares her experience moving into a private practice setting affiliated with a health system—what surprised her, how she adapted and other lessons learned.

  • Sonal Patel, MD, Magnificent Minds Neurology Center
  • Carol Vargo, director, physician practice sustainability, American Medical Association

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Vargo: Hello, and welcome to AMA Thriving in Private Practice. A 10-episode series exploring the unique needs of physicians in private practice settings. In our show, we talk about efficiency solutions, how to transition into the world of private practice as well as tools to help free up time so you can focus on your patients. I'm your host, Carol Vargo, director of physician practice sustainability at the American Medical Association. Today, I'm joined by Dr. Sonal Patel of Magnificent Minds Neurology Center, a pediatric neurology practice in Bethesda, Maryland. Today we're going to talk about her experience and advice on what to expect when considering moving into a private practice setting affiliated with a larger medical group.

Dr. Patel, thank you for joining me today.

Dr. Patel: Thank you for having me today, Carol.

Vargo: Great. So let's get started. First, can you tell our listeners about your work, your practice, where you trained, how long you have been in practice?

Dr. Patel: Sure. So I am a double boarded pediatric neurologist and pediatric epileptologist. I trained in Chicago and then started my first academic job in Los Angeles. And after there, I left and went to a solo private practice.

Vargo: So you noted that you were in an academic setting before entering into a private practice setting and a solo one at that. What led you there?

Dr. Patel: Initially I was looking for an academic practice after training for increased experience and exposure to more complex cases. And while I was at that academic practice, I did realize that I wanted to have some more autonomy over what I was doing with patients as well as my own schedule. So I left the academic practice to go in a solo private practice, primarily for those reasons.

Vargo: So we've talked a lot with other guests on this podcast about having the background and the skills to start your own private practice and where you obtained those skills. Could you share a little bit about your journey there? Did your training, or your setting in an academic medical center prepare you at all? If not, where did you find the information to get you started in private practice?

Dr. Patel: That's a great question. So in academic practice so much is done for you that you don't get exposed to the business ins and outs of practice. And so I felt as though I got my experience mostly from the solo private practice, being an associate there but still having responsibilities for things such as billing or coding and insurances. So I do feel as though that solo private practice was primarily where I had my experience prior to starting my own practice.

Vargo: So it was a lot of on-the-ground training, I gather, in terms of learning those skills?

Dr. Patel: Absolutely, absolutely. I wish we taught that more in residency and fellowship as well as academic settings, but unfortunately it is on-the-ground training.

Vargo: And did you find that came easy for you? What were some of the big challenges that you may have faced?

Dr. Patel: I do feel that I was always interested in the private practice business model, so it was something I was interested in and did come easier to me than I think some other physicians. I do feel as though the things that were difficult were primarily things like billing and insurances, because that was something I really wasn't previously exposed to or responsible for. And being in private practice, whether you're ordering tests or figuring out medications that are on formulary, those are done through a system that insurance is required to authorize. And so you do have more exposure to that in private practice.

Vargo: And did you have just sort of experiential practice or experience that you just learned as you went or did you rely on any specific programs? I've talked with other fairly new private practice physicians who said they relied on maybe Facebook groups or Instagram folks about how to do some of these new skill sets. How did you pick up these skills?

Dr. Patel: So I am not on any type of social media, so unfortunately those were not options for myself. But I did feel as though there's research to be done on the internet, which was a primary source for myself, as well as using my colleagues in that solo, in private practice, just that also had other private practices in the area. So I do feel like even in that setting, I had other physicians to contact. So all of that was very helpful prior to me actually starting my own practice here in Bethesda.

Vargo: Yes, I think one of the things we talk about the AMA is enhancing that ability for networking for physicians around the private practice model. And I think that's something that we're going to be pursuing in the future. So hopefully your colleagues coming up into this practice mode will have potentially some research and resources prepared for them ahead of time. So that's a goal of ours and that's based on experience that we've learned from physicians like you who have shared their journey. So this is really important for our listeners.

Tell me a little bit then, you're in private practice in Bethesda, Maryland. Pediatric neurology. How long were you in that private practice before you began to consider joining a larger medical group?

Dr. Patel: So I was in that practice in Southern California for approximately two years and then our family was moving to the east coast. So when I was making that transition to a new area, one of the things I was looking for was to start my own practice and be part of a larger medical group so that I wouldn't feel so solo and on my own. So I actually sought out different larger medical groups where I could still have my own private practice, but be affiliated with a larger group.

So I did research on the internet, as I mentioned, to find groups that I would be interested in and I came across Privia Medical Group. And once I did, I reached out to a colleague who I did not know in Privia, called an adult neurologist, and asked if he could tell me a little bit about his experience. And he was extremely gracious in offering me that assistance and taking the time to talk with me and talk about what it would be like to start a private practice and be a part of Privia Medical Group and the support that I could have with that group.

Vargo: So tell our listeners who may not be familiar with Privia, a little bit about what the medical group is and how it's structured.

Dr. Patel: So Privia Medical Group is a larger medical group. I believe they have approximately 1700 physicians across the country that are all in private practice. So you have your own office, you run your office exactly the way you want to, but you have the support of having the same electronic medical record system and billing system and ability to look at your charts with your colleagues that are also part of Privia Medical Group. And that's extremely helpful for someone such as myself, who is a specialist and I'm getting referrals from pediatricians in our larger medical group in our region, so that I can review their notes in any testing that's been completed and they can do exactly the same when I see the patient as well.

Vargo: So you mentioned a common electronic health record, which I think is very important, particularly for efficiency and to your point about care coordination and that handoff and that referral network. What other benefits, besides maybe that piece of what I like to term infrastructure, that really helps these private practices manage the care coordination, all these other aspects that have made running a medical practice pretty complex these days, what other or types of efficiencies does Privia offer you?

Dr. Patel: So one of the biggest efficiencies is credentialing. They completely hold your hand through all of your insurance credentialing. Once you are licensed appropriately for what region you're in. So that was very helpful. The other thing is compliance issues where they, as a whole group, know what we need for HIPAA compliance. And make sure as a group that we are partaking in those programs and completing those programs in a timely fashion. And they do monitor that as well. So I feel like from that standpoint, it reminded me of the academic hospital setting, where things were set for you, so that you knew you were compliant in every manner without having to worry about what things you were missing.

Vargo: Those are really important, I think, supports so that you are spending more time with your patients, hopefully, which I think is what many private practice physicians are drawn to and that business model. A couple other things I'm curious about. What about things that we hear that are often pretty burdensome for physicians in terms of quality reporting? Do you have to do any of that kind of tracking and does Privia offer that assistance as well?

Dr. Patel: So they do. I feel the quality tracking is more for primary care physicians, less so for the specialists. So it doesn't personally apply to me as much as it does for the pediatricians that I work with.

Vargo: That's a great distinction, thank you. What about contracting with health insurers?

Dr. Patel: I thought that was one of the most helpful parts when I started the practice, because they really do help you through all of that and help in a timely fashion where you're not worrying about, did this get returned or not. They've got to entire team that works on credentialing that you just submit your information to and they take care of that on their end.

Vargo: That's great. So I assume then that allows you to not have as many staff employed in your own practice because they're taking care of that for you?

Dr. Patel: Absolutely the credentialing as well as one other component which is the IT portion of having a practice. That was something I was completely unfamiliar with prior to starting a practice myself. And they have an entire team that when you join Privia, they will help set you up with all of your IT needs in your new office and connect you to the EMR and make sure that things are working properly and you have someone to call when there is an issue.

Vargo: Very helpful. So you've talked a bit about all that infrastructure and support they're providing you, which obviously is a great benefit just from a practice perspective as a physician. What do you really enjoy the most about being part of this medical group?

Dr. Patel: I enjoy the support the most. I do feel very supported by having colleagues that I know I can contact and state just that, "Oh, I'm a provider with of Privia. Can I ask you a few questions about that?" And that's been a very helpful networking tool for myself. Also, I find the referral system to be extremely helpful. Where when you are serving your own specialty practice to have a built-in set of primary care physicians, whether it's pediatricians or family practice physicians that are looking for your specialty. You are part of the system and you'll come up as a referral. And Privia also has quarterly meetings with these different groups to present you as a new provider in the group, so that you can let them know what services you're offering for the patients as a group. So I do, I find those things the most helpful at starting a practice and continuing to grow the practice.

One additional thing I also find Privia so helpful in is recruiting different levels of providers into your group. So about a year after I started the practice we were growing and I needed to add a mid-level and they have a recruitment service through Privia that helps you find a mid-level. And currently we are now adding a physician and Privia was able to help me recruit and obtain a new physician that will be starting in the fall with us.

Vargo: That's really beneficial, particularly now where I know that staffing shortages and the quote unquote "great resignation" has been impacting private practices in particular, we hear a lot about being able to recruit and retain staff. So it sounds like Privia is really helpful to you in that respect.

Dr. Patel: Absolutely.

Vargo: Okay, great. So it sounds like there's been quite a few great benefits by joining a Privia Medical Group to your practice. Are there any others that we may not have covered yet?

Dr. Patel: One of the things I was thinking about was malpractice and recently what happened is our malpractice rates went up significantly within Privia Medical Group. And as a group, we were able to negotiate with another malpractice provider for a significantly lower rate, which as a solo practice, would've been very difficult to do.

Vargo: So it sounds like they're providing you that benefit of sort of group negotiation, which really is having an impact on your bottom line as a business operation.

Dr. Patel: Absolutely.

Vargo: Okay, great. It sounds like your experience moving into this model, being affiliated with a medical group has gone very well. Any other issues that arose when you were transitioning into this type of practice? Sounds like there's been a lot of benefits. Were there any challenges?

Dr. Patel: I would say the biggest challenge was transitioning to a new electronic medical system and getting used to that system and personalizing that system to be of the best benefit for efficiency in our practice as a solo provider. And so one of the things that I've found the most helpful from Privia was that they send a consultant to your office while you're starting the practice to personalize your electronic medical system for your specialty or how you like to answer questions or how you like to do your notations. Or for me personally set up my dictations so that it was live time. And I just found that to help my patient flow daily so that I have nearly no work for the office when I go home. All my notes are done live time, which I just think improves accuracy and just efficiency. So I'm not spending hours at night doing notes or having to wait for dictations and approve them because they're happening live time.

Vargo: That sounds like a tremendous benefit because I know so many physicians are spending hours outside of work with documentation. So that's really wonderful. And also really just adapting to a new electronic medical record, I think is a big lift. So the fact that they're offering you that training sounds really important.

Dr. Patel: Absolutely. And one other thing that they do moving forward. So once you're a new practice, you actually have a consultant meeting monthly to actually review your financial state in terms of your billing. They're looking at all the backend for you and reviewing it with you so that I'm not spending to time doing that myself. I've got a set hour. I do that once a month and they are looking at all the back end for me to see how my billings, collections, all of that is going. Which I really appreciate and don't feel like I need to spend time outside of that hour because they're doing all the work in that way.

Vargo: So it sounds like they're very collaborative when you're having these conversations around things like billing and financing. Does it always go smoothly? Are any tips that a physician would need to know about how to work with the staff at a large medical group?

Dr. Patel: I have always found it beneficial and helpful for myself. I feel as though they've been nothing but supportive in making us a successful practice and helping us grow. And anytime I've asked them for help, I feel like they're at the ready to dive in and figure out solutions.

Vargo: That's great. And I want to hone in on a bit on that asking for help. Because I think what we do find, and I think particularly for those who may have been in private practice for quite some time, I do get this sense that many physicians feel like they have to do everything on their own and may be reluctant to really enter into these more collaborative arrangements. Any thoughts about that aspect of it?

Dr. Patel: I feel like that's probably one of my favorite things is having to ask for help. Because it is a daunting task to start your own business when you're trained as a medical provider. They're not the same type of training. And so to be able to have that help, have a place to ask for that help, I think it was what gave me the confidence to move forward was starting my own practice.

Vargo: That's great advice. Thank you. Anything else that Privia offers?

Dr. Patel: They help us with our marketing, including our website design and business cards and any flyers or pamphlets we want in our office about our practice. So that's been a tremendous help to have a place to go for all of that.

Vargo: That's really important. We hear that from private physicians as well, because to really, I think, remain competitive in your market, you really do have to have that brand. And it sounds like they've really been helpful to you in that.

Dr. Patel: Yes.

Vargo: That's great. So let's shift and talk a little bit about maybe lessons learned as you moved into this practice setting from being in your own practice into this group. Are there any big lessons, takeaways that you've learned that you could share with our listeners who may be considering a move into a larger medical group? What are some lessons, benefits, things you wish you knew before you were entering into this journey?

Dr. Patel: I think starting my practice with the medical group was probably the most helpful thing I could do. I feel like they were able to hold my hand through the process and I always felt supported and knew I had a place to ask questions and get answers from. And even though I was starting my own practice by myself, I felt as though I had an entire group to help me with that process. And so one of the things I would recommend is, just as I did myself, look to find a group like that. If you are thinking about starting your own practice, because you do feel supported in the way that I think a lot of physicians feel supported by an academic setting, except you can do it in a private practice setting.

Vargo: So maybe to pull this out a little bit more, I mean, you know, describe your day to day in terms of what you think the benefits might be of participating in Privia versus when you were in a private practice, not affiliated with the group. Is there any changes in your practice day?

Dr. Patel: Sure. So one of the things I think I'm just significantly more efficient because a lot of things on the backend are taking care of by the group. Whether it's billing, whether it's collections, whether it's referrals, all of that is just set as part of being in this group. So those are things I don't worry about. I don't have to take time out of my schedule to look at those things because they're already being done for me. So it's more time for me with my patients.

Vargo: And I think that is the value in this type of model. I think it's also a value that many hope would come through in being in private practice as opposed to being perhaps in a larger system where you're not necessarily as nimble.

In fact, I actually hear some hustling and bustling the background. Are you at your practice office right now?

Dr. Patel: Yes, I was taking my lunch break and patients have arrived for me to see this afternoon.

Vargo: Oh well. And I'm sure all of our listeners can relate to this. Thank you for taking time out of your busy day to share with us your experiences. Is there anything else as we wrap up here that you would like to share with our listeners that we haven't really covered? Any last words, wisdom, thoughts to pass on?

Dr. Patel: The one thing that I would mention is just the appreciation we get for our practice on a daily basis from our patients. And I feel that's the result of being a small private practice, but also having all the benefits of being a part of a bigger group where things are streamlined, things are efficient. They're able to talk to their doctor. They're able to get an answer quickly and a response right away. I think that's the biggest reason most of us go into medicine so we can help patients and in a timely fashion. And I feel that's the most rewarding part of my day is I feel I get to make that impact directly and without the bureaucracy and trouble of being in an academic setting and yet being able to deliver great quality of care.

Vargo: Well, that really says it all. I think that your experience is one that we hear so much from our private practice physicians and what I think many physicians who are either considering transitioning either back to that model or starting that model, are really seeking. So I really appreciate you taking time out of your busy day to today, recognizing that you are seeing patients today and you're on your lunch hour. So thank you so much for doing that. And thank you for sharing your experience, your journey, and talking with us today about Privia.

Dr. Patel: You're so welcome. Thank you for having me today.

Vargo: For more information, visit [the AMA website] to support your practice's sustainability. I'm Carol Vargo. And until next time, this has been Thriving in Private Practice. Thank you for listening.


Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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