In 2011, after completing her pediatric otolaryngology fellowship at the University of North Carolina School of Medicine in Chapel Hill, Alisha West, MD, knew she wanted to work in an academic hospital. “If you look at medicine in general, the future and the progress lie in the academic institutions where they’re doing the research and they’re teaching the residents,” she said. She is now a pediatric head and neck surgeon with University of California Los Angeles (UCLA) Health.
Eric Mansfield, MD, was drawn to private practice after serving four years as an otolaryngologist in the United States Army. In the structured environment of the military, “there were always people above you who were making decisions for you,” he said. “I knew I didn’t want to work in another system where I couldn’t make my own decisions.” In 2001, he opened his private practice in Fayetteville, N.C.
If you look at medicine in general, the future and the progress lies in the academic institutions where they’re doing the research and they’re teaching the residents —Alisha West, MD
An Atmosphere of Collaboration
While solo practice has attractive benefits, including autonomy and the potential for higher income, the number of otolaryngologists in solo practice declined by 5% between 2001 and 2009, according to a 2011 report from the American College of Surgeons (ACS Health Policy Research Institute, January 2011). For urban otolaryngologists, the decline was 15%. One theory to explain these trends is that younger physicians tend to want the more dependable income that comes with hospital employment (or a group practice) and are less interested in the business and administrative tasks that come with running a small business.
Dr. West, who is also an associate professor of otolaryngology at UCLA, was drawn to hospital employment, specifically at a tertiary care center, because she wanted to work with very sick patients. “For me, it brings a lot of excitement and joy and fulfillment to take care of those patients,” she said. She also enjoys collaborating and operating with a diverse group of colleagues from various subspecialties, performing research, and taking in the invigorating energy of a college campus.
But, she said, an academic hospital might not be the right fit for otolaryngologists who want a balanced lifestyle. Dr. West, who covers three UCLA hospitals, often works from 7 a.m. to 7 p.m. and takes call 22 days a month. “At an academic institution, we do long hours,” she said. “And we do extra things like research and teaching residents, all on our own free time beyond our clinical practice. The lifestyle is probably not why you go into academic medicine.”
Ray Cameron, MD, PhD, who has been, throughout his career, essentially the only otolaryngologist in Iron Mountain, Mich., a town with a population of 20,000, entered employment with a hospital after 23 years in private practice. As he was getting closer to the end of his career, he decided to join the Dickinson County Healthcare System in 2013. Here, he no longer has the flexibility in his schedule that came with working for himself. But, “now I don’t have to worry about billing and collecting like I did when I was in private practice,” he added. “I can concentrate on the care of patients, the surgery, and the clinical practice of medicine.”
For otolaryngologists interested in solo practice, the idea of building a patient base while running an office can be overwhelming. This was the case for Vandana Kumra, MD, FACS, a general otolaryngologist at ENT New York in New York City. “You have to put a fair amount of money into buying equipment, you have to hire staff, you have to figure out how to do billing, [and] you have to rent a space. It’s basically setting up a small business and then finding patients to come to you,” she said.
So, in 1998, after completing her residency, Dr. Kumra joined another physician’s office. There, she could build up a referral and patient base while learning how to run an otolaryngology practice. “To be able to work for someone for some time and learn the business that way, I think for a generalist makes a lot of sense,” she said. Dr. Kumra remained the second otolaryngologist in this two-person office until 2011, when she opened her own practice in Manhattan.
After opening a practice, the biggest challenge, said Dr. Mansfield, is that “you are always on; there are no breaks.” He also feels responsible for his 25 staff members, including another part-time physician, an audiologist, and a full-time allergy staff. “Their paycheck, their 401(k), their insurance, is all through us,” he said, adding that he fully understands that the health of his clinic affects the health of his staff members’ families.
If you … not only want to practice medicine but you want to control your work environment and really have your thumbprint on the community and change lives at the same time, then private practice is the only way to go,” —Eric Mansfield, MD
Your Own Boss
Still, for Dr. Mansfield, the benefits of private practice far outweigh the challenges. He can shape the culture of his office, which includes his staff’s focus on customer service and being personable with patients. Dr. Mansfield also has a rule that one patient a day who can’t afford services will get free care. “When it’s your practice, you can say, ‘We don’t have to charge that patient,’” he said. “In other places where they’re looking at RVUs and they’re looking over your head, you don’t really have that option.” He also chooses to close his office for half a day every quarter so his staff can participate in a fun team-building activity together, such as painting.
Dr. Mansfield is clear that he does not think the age of solo private practice is over. “If you really have an entrepreneurial spirit, and you feel like not only do you want to practice medicine but you want to control your work environment and really have your thumbprint on the community and change lives at the same time, then private practice is the only way to go,” he said.
Jennifer Walker is a freelance medical writer based in Wisconsin.