<p>I am confused on how private practice works. After residency at a hospital, can you decide to form a private practice by yourself? It seems like just about everyone already has his/her doctor, so i find it hard to believe that opening a new private practice would attract many patients. After three or four years of residency, are most doctors fully skilled enough to treat patients by themselves? what happens if the private practice doctor (internal medicine) does not know what is ailing his/her patient?</p>
<p>I think it is much more common to join a group practice that has already been established by more experienced doctors. It seems it would be impossible to single-handedly take on the expenses of a private practice with all of the debt from med school.</p>
<p>I would guess that a doctor that did not know what was wrong with his/her patient would refer him/her to another doctor.</p>
<p>Husband is an attorney who represents a lot of doctors--and esp those just starting up in private practice. It takes money--try to hook up with an established practice; one in which older doctors may retire in a few years. You could then end up purchasing the practice from the retiring doctor. He has handled this a lot--in fact, son's dentist has just done this!</p>
<p>Starting a practice or joining a practice will take money in some form or another. As previously noted, starting up as a solo practitioner will require money, perhaps as small business loan. Joining a group practice may require a "buy in" for the privilege of association and goodwill. Working for an existing practice as an employee will cost income, as salaried job compensation is structured to benefit the group, not the employee.</p>
<p>Attracting new patients is not hard, since many current practices are closed to new patients (particularly Medicaid and Medicare patients). Board certified physicians who join HMO provider panels get referrals from HMO primary care docs or from the HMO itself.</p>
<p>Residency training, depending on the specialty and training program, may or may not adequately prepare new docs for practice. Certain surgical procedures, for example arthroscopy or cataract extraction, require a great deal of practice to master. If a surgical training program does not provide sufficient case volume and supervision, some procedures are going to be very difficult. (For this reason, the common wisdom is that surgeons about ten years out of training are at their peak). Even with adequate skills, most graduating residents lack the efficiency of a seasoned practitioner.</p>
<p>See the article in Medical Economics entitled "Start a practice."
<a href="http://www.memag.com/memag/article/articleDetail.jsp?id=108847%5B/url%5D">http://www.memag.com/memag/article/articleDetail.jsp?id=108847</a></p>
<p>The AAMC has a nice bibliography of career resources for medical students and residents at: <a href="http://www.aamc.org/programs/cim/bibliography.pdf%5B/url%5D">http://www.aamc.org/programs/cim/bibliography.pdf</a></p>
<p>Just wondering if someone here could elaborate on the idea of joining a group practice. How do you find partners? If/when you do find partners, how does the pay work? Do you buy into the group or do you get payed per patient?</p>
<p>People find jobs in several ways. The traditional method is to hear of a good practice, perhaps from a former resident from your training program; another traditional method is to scour classifieds in the back of relevant medical journals; the most common method these days is to search on the internet.</p>
<p>Pay schemes vary widely. Remember that most third party payments are based on encounters or procedures. </p>
<p>The simplest payment scheme is straight fee for service (also known as "eat what you kill"); in this scheme your compensation can fluctuate wildly as a function of payor mix (good insurance, medicare, or uninsured) and encounter spectrum.</p>
<p>A second and common scheme looks at the relative value of work done, but pools insurance payments to take out the variation due to payor mix.</p>
<p>Buy in's range from nothing to tens of thousands of dollars. Some punitive practices entice physicians with a promise of partnership preceded by a period of modest salary and then later find excuses to deny partnership.</p>
<p>A third scheme pays straight salary or a fixed proportion of practice net income.</p>
<p>Other schemes include hybrids of salary and productivity.</p>
<p>^^ So would you say it is hard to find a group to join if you're looking to go/stay in a certain city?</p>
<p>The availability of jobs depends mostly on the city in question, compensation requirements, and your specialty. In most cases, your actual medical school and residency institution matter only very little or not at all.</p>
<p>The NEJM site is good place to start, especially for internal medicine. <a href="http://careercenter.nejmjobs.org/search/results/index.cfm?job_category=2911&ss=1&sn=10%5B/url%5D">http://careercenter.nejmjobs.org/search/results/index.cfm?job_category=2911&ss=1&sn=10</a></p>
<p>The websites of the major journal for a specialty are usually helpful, but for some specialties, de facto clearinghouses for jobs exist. Another option is working as locum tenens physician in various sites to figure what style of practice you like. Locums can be very difficult for a new physician because essentially all aspects of practice are unfamiliar.</p>
<p>This article in Health Affairs discusses the [somewhat] free market dynamics of medicine.
[quote]
Most residents train in urban settings, especially in New York and Boston. Convincing a twenty-eight-year-old resident who grew up in New Jersey, went to college in Los Angeles, and attended medical school in New York to move to Kansasbecause doctors are needed thereis a hard sell. This is why starting salaries for graduating residents can be two to three times higher in rural practices than in metropolitan areas.
[/quote]
[quote]
The free market, gummed up by a highly regulated health care system, eventually works. When there was a relative glut of new anesthesiologists about ten years ago, private medical practices responded by dropping starting salaries. Medical students responded by refusing to go into anesthesiology residency programs, worried about their post-training economic future. Faced with fewer applicants, the programs themselves responded by cutting training slots, which has slowly resulted in a shortage of new anesthesiologists.
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<p>If you have a specific city and specialty in mind, it should be determine the relative demand now.</p>
<p>Thanks for the info!</p>