Over the past 5–10 years, I have read a number of articles that describe solo practitioners as a dying breed. In primary care, the transition to shared care by teams of providers (including physicians) and the development of primary care networks have accelerated this change. I have not come across any new family medicine graduates in the last few years who plan to enter solo practice. The concept of setting up and running a practice is too daunting, particularly if that physician wants to start off their practice with an EMR. This is not the case with specialists. Even though many may wish to work in either a single specialty group setting or multi-specialty practice, there are a number of specialists who continue to work in solo practices.
The benefits of solo practice are well recognized. These include the ability to:
- Make your own policy and financial decisions about how you want to run your practice
- Spend as much time as you feel is appropriate with your patients
- Create stronger, more personal bonds with patients
- Employ the staff of your choosing and control your own schedule
In 2013, in the face of financial, administrative, and oversight pressures, can a solo practitioner survive? If so, what strategies should be considered in order to do so? The answer is yes, but physicians wanting to retain their independence and continue to practice solo need to be creative in order for their practices to remain viable. It is important to keep your overhead costs down and to run as efficient a practice as possible.
Some suggested strategies include the following:
- Take advantage of provincial EMR incentive programs and implement an EMR that is appropriate for your practice setting. In small practices, ASP- or cloud-based EMRs are a good choice because they do not require a local server or expensive hardware. Frequently these EMRs will run on low cost desktops or tablets, as most of the intensive computing takes place in the cloud. Backups are also handled centrally by the vendor, reducing the need to keep local copies of data in case a server fails. However, do your research, conduct site visits, and speak to colleagues before selecting a system.
- At the present time, EMRs in most settings have yet to achieve true interoperability with other systems. The advantage of the Electronic Medical Record is the ability to share information efficiently electronically with other clinicians and ancillary care providers. Once we have widespread interoperability between systems, the ability to practice in a solo setting but still function as part of a virtual group will become a strong facilitator for those who want to work solo. I am often asked by colleagues whether they should wait for interoperability before implementing an EMR. My advice is to choose a system that will best match their needs and get on with adoption. Over time, once a critical mass of EMR users exists, the interoperability will take place more quickly.
- A concierge practice is another viable option. Patients are charged an annual fee to belong to the practice. As a result, a physician can care for a smaller number of patients and provide a concierge level of care with the annual fee offsetting associated reductions in revenue. For example, a concierge practice of 500 patients in which each patient pays an annual fee of $300 generates a baseline revenue of $150,000/yr. Some physicians are integrating remote consultations, tele-consults, and using other tools such as text messaging to provide a level of care that differentiates them from a more traditional family practice. It is important to ensure that any practice following this model does not contravene the Canada Health Act and that patients are not charged for services covered under their provincial payment system. It may be necessary to completely opt-out of the provincial payment program. In addition, a number of provincial licensing bodies publish guidelines on the use of Annual Fees.
Are you in solo practice? Do you intend to join a larger group or have you found a way to maintain your independence? Share your experiences by clicking on the “Comments” link below.