Group practice vs. solo practice (2024)

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Dr. Jai Parekh and Dr. David Goldman debate the pros and cons of working in a group and working for yourself.

CEDARS Debates is a monthly feature in Ocular Surgery News. CEDARS — Cornea, External Disease, and Refractive Surgery Society — is a group of cornea, cataract and refractive surgery specialists, here to discuss some of the latest hot topics in ophthalmology.

As the landscape of medicine continues to change, both new and experienced physicians face the decision of how to manage their practices. This month, Dr. Jai Parekh and Dr. David Goldman discuss the benefits of group practice vs. solo practice. We hope you enjoy the discussion.

Kenneth A. Beckman, MD, FACS
OSN CEDARS Debates Editor

Group vs. solo: I say, go group

Growing up, I enjoyed playing second base and eventually became captain of a baseball team; working as a team player with a bunch of athletes was much more appealing for me than serving up a ball in tennis and winning an individual match — Jeter vs. Federer.

Not much has changed 30 years later. A typical question a graduating trainee or even “midlife” ophthalmologist may ask in these changing times is, “Should I join a group or hang out my shingle?” I would say, “Join that practice!” When deciding which path to take, there are several things to consider, including clinical and financial risk, resource control, market access, average income and lifestyle. The phrase “solo practitioner” may be arcane in the next several years.

Traditionally, group practices enjoy the benefit of greater shared clinical experience and access to information. The practice may be a multispecialty eye group including comprehensive, retina, glaucoma, cornea and oculoplastics. This enables you to better care for a patient and “curbside” your associates as needed. My partner, time and time again, will run a corneal ulcer or difficult anterior segment case by me while I will “throw him” a few nerve palsies that I would rather not deal with longitudinally. With our multispecialty eye practice, we only refer patients “out” a few times each year.

In addition, group practitioners have greater access to more patients than do solo providers. By having a practice with multiple physicians, staff members and even multiple locations, this broadens the scope of the practice and enables a group to provide care to more patients and connect with more referrals. This also assists with tough negotiations with insurance companies on trying to get higher reimbursem*nt rates in an era of the “slow death spiral” in which we are getting paid less per patient each day. Remember, consolidation these days in local markets is inevitable, and as ophthalmologists, we need to be part of the health care system, not outside of it. Group practices have more strength.

On a fiscal note, a recently released Medscape survey showed differences in ophthalmology incomes across America based on practice settings. In ophthalmology, office-based single-specialty group providers earn an average of $325,000 annually, while office-based solo practitioners earn an average of $291,000 annually. In a group practice environment, it is also common for most practices to offer some type of bonus or productivity incentive to all providers.

Finally, one of the most advantageous reasons for practicing in a group practice is the ability to have more control over your lifestyle. These providers will be able to control their hours, vacation and holiday schedules, on-call schedules and general lifestyle choices more than solo practitioners. When working with a group of other physicians, it is more likely that when an emergency arises or you have to change your schedule last minute, one of your colleagues will be able to cover for your hours. When working in a solo practice, you can rely only on yourself, and patients can potentially get frustrated when situations such as this arise.

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There are also opportunities in a group practice to tailor what you like to do. For example, there may be those partners who like to manage the business of the group vs. those who may prefer more research; there may be opportunities to have evening or weekend hours vs. those who only want the straight 9 a.m. to 3 p.m. hours.

Overall, the advantages of practicing in a group practice environment significantly outweigh those associated with a solo practice. Group practices are more rewarding in terms of clinical, financial and lifestyle aspects.

I enjoyed turning over the double-play ball with my shortstop and first baseman decades ago. Group practice is the way to go.

The benefits of solo practice

When I was completing my residency, the thought of doing anything other than joining a group practice never crossed my mind. In fact, some of the things I enjoyed during my attending years at Bascom Palmer were the interactions with my colleagues. As we hear more about ACOs and contract negotiations, the theme of “bigger is better” certainly occurs more frequently. That said, when I decided to leave academia, I was unsure whether to go solo or join a group. Two years into private practice, I am thankful I chose to go solo, and I would recommend it to anyone considering starting their own practice.

Of course, there are downsides to solo practice, but oftentimes these disadvantages are overly weighted. For example, a group practice offers shared overhead, collegiality and coverage for when you are on vacation. Let’s examine each of these “advantages” to group practice.

While it is true more physicians should bring down overhead, many times it does not. More doctors equal more space, more technicians and possibly more equipment. Even when talking about the most expensive OCT devices, this is not overall a big cost compared with personnel, especially once tax advantages such as section 179 and depreciation values are factored in.

If you are a cornea specialist, it might seem great to have a glaucoma specialist next door in case you have a tough case you think they can help on. Practically speaking, this does not happen in the real world. To begin, you may have multiple offices, and that specialist may be in another location. Perhaps that specialist is on vacation. Even if he is in the office with you, he will typically request to have the patient seen on a separate day because you cannot both bill for a visit on the same day. It is also great to be friends with your co-workers, but in today’s style of practice, you are seeing so many patients in a day, you will barely have time to eat lunch, let alone chat with your partners.

Although you can easily arrange coverage when you are on call in a group practice, it is actually easy to do this in solo practice as well. Let’s now examine the advantages to solo practice.

The most obvious advantage would be control. You have complete control over who is hired, how the practice runs, when you want to take vacation, what type of health insurance you want, and so on. For some, this may seem like too much control; however, a good practice manager can help guide you in the right direction. While it is true that the office makes less money when you are not there, the reality is that when you are in a group practice, you are still not making any money when you are not in the office. To negate this effect, I offer my employees an extra week of vacation if they take vacation on days I am not in the office. This keeps everyone happy and keeps my overhead down.

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On that note, overhead in solo practice can be kept low. With electronic health records and practice management systems slowly replacing medical record rooms and billing specialists, a high-tech office with the latest equipment can run much leaner than long-standing practices.

When you want to change something in a group practice, a meeting has to be called. All members have to find a time that works (typically after 5 p.m.), and then a debate may ensue. This could be over hiring/firing employees or something as simple as a decision to purchase new equipment. In my office, any change I want to make can occur instantly. A simple example: Patients in the waiting room were arguing over what channel should be on the TV. An employee suggested playing a Blu-ray movie; $95 out the door at Best Buy a couple hours later, and patients were now quiet, ooh-ing and aah-ing at the thrills of Planet Earth.

Patient care can also be more concierge-like in a solo practice. Call many private practices, and you will be greeted by a computer menu. When patients call my office, they get a real person, and because it is smaller than a group practice, my staff can remember the patients. Many times we are complimented on the personal care and attention they receive, and patients will mention they have never encountered care like this before.

Finally, there is the thrill. This is not some clock-in clock-out job that you may dread heading to. This is a reflection of you, and as it grows, there is a lot of excitement. I find myself happy every day I wake up to head to work, and that is likely one of the greatest measures of job success.