'Why I Stay Independent'

June 3, 2013

Solo internist Neil Nelson says he's not doomed to extinction - in fact, he thinks there might be a backlash if more physicians feel the way he does.

They say independent physicians today are dinosaurs doomed to extinction - which I suppose makes me a Triceratops or something. Though in reality, I'm not so sure we are as endangered as many people think. Physician employment clearly is the trend of the present, but it wouldn't surprise me to see a backlash if more physicians feel the way I do.

Personally, I enjoy my independence. It's good to know when I come into the office in the morning that I have control over the things that matter to me; including the employees I hire, the hours I work, and, most importantly, the care I provide to my patients.

Part of my continued satisfaction with independent practice is no doubt a result of the fact that I am an old-school "country doctor." I provide care for patients with whom I grew up in the small town in which I was born and raised. I have known some of my patients all of my life and now care for their children and even their grandchildren. Yes, I still make house calls and occasionally my patients pay me in kind rather than cash.

With these types of connections, I don't think I could tolerate an environment in which an outside party dictated or overly influenced my clinical judgment or the quality of care I provide to my patients. When Staff Care chose me as their "2012 Country Doctor of the Year," it certainly was a personal honor, but also, I believe, a validation of the private-practice model. When you are in private practice, being a physician is simply who you are. I'm not so sure that is the case when you are just another employee of a big health system.

Also, I was raised on a farm and even as a physician I have continued to spend time working my family's 300 or so acres. I'm used to long days, hard work, few vacations, and attending to emergencies whenever they arise. As a private-practice physician, I make a virtue of self-reliance.

That is not to say that I am on an island. The local hospital has always provided me with excellent resources and the backup of a wide range of specialists that is unusual for a critical access facility. My physician assistant, Anne-Marie Richmond, has been with me for 15 years, providing a level of support and camaraderie that I think would be hard to find in an employed setting. One of the great benefits of being in private practice is you are your own HR director. You can build a staff that you are comfortable with that offers continuity, strong ethics, and commitment to the practice and to your patients. There is a genuine pride of ownership in something you have built and that drives you to go the extra mile, which I think is ultimately good for patients.

I know that some physicians, particularly in primary care, are having a hard time maintaining the financial viability of their practices in the face of rising costs and escalating regulatory/health IT burdens. We just implemented an EHR into the practice so I know the drill. But at least I know that in private practice (so far, anyway) I get rewarded for my level of effort and productivity. I can choose my patients and decide how much free care I want to give. With the help of a good team I have been able to stay efficient and maintain a healthy income, even though rural patients tend to have low per capita incomes and high rates of poverty. It helps that I have a broad level of training and can do a lot for my patients.

There is no doubt that you need maximum commitment to be a private-practice physician. I go home tired just about every night. But when I wake up, I can't wait to get to my practice and see my patients.

Neil Nelson, MD, is an internist/pediatrician practicing in Gibson City, Ill. Why do you stay independent? Tell us at editor@physicianspractice.com. Unless you say otherwise, we'll assume that we're free to publish your comments in print and online. Have a "Bigger Picture" opinion of your own? Send it along via e-mail and we'll consider it for a future issue.

This article originally appeared in the June 2013 issue of Physicians Practice.