The idea of becoming an independent clinician at first sounds like all the good parts of the job without the burden of a boss. In some ways, that’s not entirely wrong. Independent practice does give you the ability to set your own hours, make your own decisions, and potentially experience higher levels of freedom than would be possible working for a hospital.
That’s in theory, anyway. In reality, many independent clinicians wind up trading one set of responsibilities for another. In this article, we take a look at how the decision to go independent actually changes what job you’ll be doing.
Welcome to the World of Business Ownership
That’s right. While anyone who’s ever dealt with the healthcare system doesn’t struggle with the idea that it’s a business, rarely do we see clinicians themselves as business people. However, once a clinician decides to go into private practice, that changes.
All of a sudden, there are a whole host of responsibilities that used to get handled by the hospital that now need their own set of personnel to address. For example, billing: who sends out invoices, who itemizes them, who ensures that payment has been collected? If there’s a dispute, who addresses it? What is the process for handling that kind of dispute?
Who deals with the insurance companies? When it comes to credentialing, who makes sure everyone on the staff has the right background for the tasks being handed to them? If there’s a malpractice complaint, what kind of coverage have you set up for yourself, and how is that handled?
Then there are tons of infrastructure and administrative concerns: note-taking, equipment, documentation requirements, dozens of little tasks that need to happen while the clinician is focused on healing.
In an established hospital setting, it’s the healthcare system that handles all of these admin and infrastructural tasks, so that the provider can give all of their attention to the patients.
In private practice, there’s none of that. At this stage, you’ve cut out the middleman, and while there were things about said man that you probably didn’t like, it turns out he was also doing vital work that needs to be replaced.
So who handles replacing it? That, dear independent clinician, is you.
New Job Categories
Of course, the clinician themselves generally isn’t going to become their own finance and admin department. They’ll hire out. Most likely, they’ll need to find a business manager to handle greasing all the wheels to make sure that everything goes well.
There’ll need to be someone from bookkeeping, bill collection, administrative work, legal requirements fulfillment, and more. Even a small office may require a half a dozen or more employees to ensure everything is going smoothly.
The clinician themselves may not even know what jobs are getting done beyond the rooms where they see patients. That is where an office management firm comes into play.
They will handle many of the logistical elements, so that you as a clinician can focus less on business and more on the patients themselves.
That’s a good thing, but it also creates an added element of volatility that generally doesn’t apply to clinicians working within a hospital system.
The Shortcomings
There are a few potential areas for friction that bear consideration. First of all, you should ask yourself what will happen when something breaks.
No, not literally, although sometimes that too. We mean what happens when your receptionist doesn’t show up to work? What happens when your bookkeeper bails, or you can’t find a good nurse to get on your staff?
What happens when you have a large outstanding invoice that won’t get paid? A clinician might see 20 to 40 people per day. During that time, many, many things can and probably will go wrong.
In a well-developed healthcare ecosystem, there are generally canned solutions to every problem that the clinician themselves don’t need to worry about. Even within that highly controlled environment, some stress inevitably does still splash up on the caregiver, but they are at least insulated from taking the brunt of it.
When you’re in private practice, that insulation is often not there, particularly in the early stages when margins are a lot thinner and you’re still learning the ropes.
Income Volatility
Add to this mixture inconsistent pay. When you’re employed by a hospital, some of your compensation may stem from the number of people you see, procedures you completed, or other factors tied to revenue and productivity.
That said, you’ll still typically have a minimum earnings threshold that provides you with consistency and stability. In private practice, that’s usually not in place.
You’ll likely find that your earnings take a considerable dip during your first year in practice. This will partly be due to the weight of startup costs, which can be considerable, and also from the fact that you’ll probably begin private practice with a lower volume of patients than you had while working for a hospital.
Over time, the numbers may actually skew in the other direction. In private practice, earning potential statistically tends to rise with time. That’s because you’re getting a larger piece of the pie than you would working for a healthcare system.
That said, the volatility and inconsistency is difficult for many clinicians to handle. You need to go in being prepared to take at least a temporary pay cut.
Is Private Practice Worth It?
At this point, you’re probably wondering if private practice is worth it at all. The answer that many people come to is that yes, it still is.
The only issue comes when clinicians don’t understand that they’re entering the world of small business ownership. That’s a territory that comes with lots of rewards in the form of increased flexibility, equity, and personal satisfaction, but it also comes with headaches.
We described them in detail above, but a good summarizing sentence would be that the buck stops with you. If something goes wrong, even something that wasn’t your fault, it’s your job to fix it.
For this reason, private practice is not for everyone, and that’s okay. Healthcare has enough jobs for any qualified professional who wants one. You don’t have to go and invent your own position to find work.
If you’re entrepreneurially minded, there are great opportunities in the world of private practice. But if you’re not, you can still make a difference in your community through traditional healthcare jobs.