Monday, September 14, 2009

Melissa Young, MD: Why I'm going solo

I am embarking on a new adventure. Or what some are describing as a suicide mission. You see, for the last eight years, I have been an employed physician at a community hospital that is an affiliate of a major university hospital, and I am going into solo private practice. No, there was no major falling out, no catastrophe, nothing obvious that set this into motion. Why then, you may ask (everyone else has), am I leaving the security of employment for the uncertainty of a new practice?

Is it the need for autonomy? Is it to be five minutes from my kids’ school instead of 25? Is it because I am tired of being pulled in three directions every day? Is it temporary insanity? It is probably a combination of all of these, as well as some other annoyances I’d like to avoid and some dreams I’d like to pursue.
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Being employed definitely has its advantages. For the last eight years I have enjoyed a decent salary, good benefits, paid vacation time, and conference time. I have not known nor cared to know how much it costs to keep a roof over my head, a secretary at the desk, or paper in the copier. As part of a faculty practice, I was surrounded by peers I could bounce ideas off, curbside about patients, and complain to about the administration ( uh, I’m talking about the government, I would never complain about the hospital administration). Teaching residents and students kept my mind fresh, and I had ample opportunity to receive CME credits.

So why, oh why, am I leaving? Part of it is purely personal. My new office will be closer to home and closer to my kids’ school. And part of it is because I think it’s time for me to start calling the shots. I want to be able to choose what EHR I want to use (a subject for another post), to fire a staff member I think is incompetent, inconsiderate to patients, or just downright freaky, and to have hours during lunch or after five so that patients who work can come in. And also because, while I wanted to do a little bit of everything when I started, over the years I have been asked (a little more adamantly each time) to 1) see more patients, 2) set aside more dedicated time for teaching, 3) and commit to doing research. And while multitasking is one of those talents every doc must have to some degree, there are only so many hours in a day.

It was not an easy decision. It took more than two years of research and soul-searching. I read books, blogs, and e-newsletters. I attended practice management conferences, webinars and telephone conferences. I talked to family and friends in and outside of medicine. And while I am somewhere between excited and terrified, I think I probably know more about running a practice than most docs I know.

Melissa G. Young, MD, FACE, FACP, is an endocrinologist in private practice, an assistant clinical professor at Robert Wood Johnson, and a working suburban mother of two in Freehold, N.J. She is a regular contributor to Practice Notes.


  1. My hat goes off to you. I think you can be successful with a good core of people around you.
    The selection of those people will be your biggest investment and should give you the biggest return on your investment.
    Good luck !
    Lou Caretta, Administrator
    Urgent Care Assosiates
    Virginia Beach, VA.

  2. you will also be a geat customer for whatever EHR vendor you select. best wishes and take care.
    Dean Delleney
    e-MDs Software

  3. Wish you the best of luck.
    As a private practice doc in a small (3 doctor) practice, it's not the decision I'd be making right now. I lack confidence that our president, congressmen, and 3rd party payers will make much effort to take care of small-practices anymore.
    There's no economy-of-scale, and we spend way too much (unreimbursed) time trying to keep our business solvent.
    Remember, when overhead goes up, we can't raise our fees to compensate.
    Maybe the grass is always greener on the other side...

  4. So Melissa, you finally did it. I remember talking to you last year. Join the few of us that dare to do it - I did it 7+ years ago. No regrets but can assure you that paid vacation is a distant dream; planning for kids is a luxury; and hope you have an extremely understanding spouse. If you are still looking for an EMR you can contact me via email.

  5. Lou, I sure hope I made the right choice as far as staff and accountant. I'll post something later about the need (or lack thereof) for an attorney.

    Dean, more about why I chose the EHR I chose in a later post.

    Aaron, well, I actually made the decision before the whole Obamacare thing started. I cross my fingers.

    Arvind, yes, I remember you, too. I finally did it! I've resigned myself to not having a vacation anytime soon. And althought my husband is not in the medical field, he has been very helpful and supportive. My kids? Well, they are sort of excited that "mommy's a boss now", but they don't know that we aren't heading back to Disney any time soon.

  6. Hi, I had some your same desires, and I am 2 years into a solo private practice. It is very difficult. I have less time than ever. My income is a fraction of what it was when I was employed. My advise is to keep your over head very low!! Start off as simple as possible. I have a server based EMR, it is very expensive to maintain. You will be challenged, and grow alot.

    Good luck

  7. I am 1.5 years in private practice with a small 3 person group (3 years since graduating from residency and started as a hospitalist. I have to say I agree with all the above comments (vacation/salary). Did I regret going into it? Occasionally. But then again when I try to remember the stress of being employed...then I realized its worth it. I agree, that my opinion might change depending on what happens to the healthcare in the near future with public option/medicare cuts/ the end its all about balance in lifestyle and finances... so Good Luck Dr. Young! Godspeed!

  8. Best of luck to you. Listen to your gut. We're all in this Med Reform together, employed or in private practice. I finished residency 9 yrs ago and did what I thought I would never do: go into private practice. What did I know about business? Nothing. What did I know about living on a budget and common sense approach? More than I thought. You will see immediate gratification as your frustrations as an employee will be resolved: dreams of flexible appt times, vacation days, participating in school activities... however hang on for the unanticipated problems like IT issues, employee drama, HR, AR/AP. Me? I broke away from a multiphysician, shared-expense model last year to really go it all alone and love it love it love it! I should have done it a long time ago. Unfortunately, the business of medicine consumes me so much more now that I (still) feel guilty about the time spent away from home. Don't get me wrong though. I love scheduling at least 1 day off per month to volunteer in my children's school and we do get to schedule vacations, holiday closures, etc. as I please. The flip side is that when you're not seeing patients, you're not making money. I do agree with what was said previously that unlike other industries, we can't simply increase our fees with the rising costs of overhead. Consider some of the free, webbased EHRs. I'm not excited about my EHR but I'm so knee-deep into it and can't afford to change at this point! I saved alot of money by firing my previous office manager, ordering my own office supplies online and limiting vaccines. I simplified the employees time-off schedule and built in quarterly employee "group trips" to a local day spa, nice lunch (not sponsored by a rep) or a gift card for a job well done. Less expensive than giving raises. Look for a PEO - professional employment organization to take over the payroll and offer better insurance rates than what you would otherwise get as a very small group. Good luck to you...B Garcia PHX AZ Fam Med

  9. Congrats! You may want to meet Aaron Blackledge of Care Practice:

    Made same decision several months ago in San Francisco. He's both brave and very busy!

  10. Thanks for the advice, encouragement and warnings! Yes, it will be very different. Different challanges, but also different rewards.

  11. best of luck
    i have been in private practise for 4 years or so and love it. i love the freedom. its pretty hard to find an employed physician who is happy and satisfied. its more fun to be in control of clinical and management issues rather then listening to hospital admministrators over and over again which also results in poor treatment for patient as they are only concern about money and finances and numbers rather then human life

  12. Hi Dr. Young, I'm a patient of yours and I would like to follow you to your new practice. Is the new office up and running yet? Where can I find the address/number to make an appointment? Thanks and good luck!

  13. My old office has been pretty good about letting people know where I am. Much more cooperative than I expected. But you can also check out the website

  14. I am a patient of yours and would like to know where your new office is and the number to make an appointment.