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A decade of lessons learned from private practice


One physician reflects on her decision to leave her employer, start her own practice and how she followed (and deviated) from her startup plans.

physician productivity, endocrine healthcare, lessons learned

Editor’s Note: Physicians Practice features contributions from members of the medical community. The expressed opinions are that of the writer(s) and do not necessarily reflect the opinions of Physicians Practice or its publisher.

This month, I celebrate the 10-year anniversary of opening my own practice. Wow. Ten years. It hardly seems like it could be true.

Much as I prepared for the transition from being an employed physician to a practice owner, not everything went as planned, and I learned a lot along the way. I was already writing for Physicians Practice at the time, and I frequently wrote about the trials and tribulations of starting my own practice. I’m going to devote the next few posts on what I’ve learned over the last decade - and what has changed.

Let me start by telling you what things did, and did not, go according to my business plans. I wrote out a well-thought-out 5-year plan. I computed start-up costs - everything from computers and exam tables to paper towels and hand soap. Seeing this document again for the first time in years, I can’t believe I actually created this.

A glaring difference in my plan versus what happened in reality is my current solo practice situation. The plan had been to start solo, add a nurse practitioner (NP) midway through the first year, then add a second physician and nurse practitioner in year two. In reality, I was solo until I hired a second physician in year two, then we briefly had a nurse practitioner (NP). We never did hire another NP, and the other physician left last year, so I am back to solo practice.

Looking at projected expenses, with just two physicians and no NPs, I had been spending less on payroll than planned, though I did not take into account making contributions to employees’ retirement accounts. Given the busy nature of our practice, I am not spending on marketing at all. Since I use call forwarding after-hours, I do not have to pay an answering service. Medical waste disposal also costs less than anticipated. And because of my busy schedule, I generally don’t travel for medical education. Instead, I try to find conferences nearby or online, minimizing that as an annual expense.

I am, however, paying more than anticipated for telephone, internet and network support. Malpractice insurance costs a lot less for endocrinology than I thought, but medical, dental, workers’ comp and commercial liability insurance all cost more.

One of my objectives on my plan was to have an average of 450-500 patient visits per month within the first six months of operation and more than 700 patients by the beginning of the second year. I just looked at March 2010’s schedule, and I was seeing maybe half my target. That was a result of having a schedule that was still mainly new patients. Now that I am seeing only follow-up patients, I am probably seeing about 400-450 patients a month. That goal of 700 was based on the premise of having a NP and a second physician at the practice.

Next month, I’ll talk about what has changed over the last 10 years. One thing that hasn’t is the mission statement I wrote in 2009. It reads: “The Mission of (the practice) is to provide comprehensive diabetes and endocrine healthcare to our patients that meets or exceeds national standards. (The practice) is committed to providing services that result in high patient satisfaction, a professionally fulfilled staff and a consequently successful and profitable business.”

It is still my intent to provide quality care and a friendly work environment while trying to remain financially successful. While not everything has gone according to plan, I believe the practice has been successful, and I have learned that success comes in many different forms.

Melissa Young, MD, FACE, FACP, is sole owner and solo practitioner at Mid Atlantic Diabetes and Endocrinology Associates, LLC. As such, she is both actively involved in patient care and practice management while also raising two kids and a dog in suburban New Jersey.

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