It’s a typical morning at Sports Medicine at Chelsea in New York City. Practice owner Clifford Stark, DO, has just finished treating a patient with a sports injury and is tackling the next items on his to-do list: resolving a disagreement among practice staff and arranging to have a broken light fixture repaired. “There are major stresses, but owning your own practice is like buying a home instead of renting—you feel like you’ve created something,” Dr. Stark says.
Dr. Stark and Chris Larson, DO, who owns a solo direct primary care practice, say running a private practice nowadays is daunting, but doable. Here’s how they’re making it work.
Taking the reins
Dr. Stark used to work for New York-Presbyterian/Columbia University Medical Center, which owned what is now his practice. In 2005, the medical center decided to shutter the practice, and Dr. Stark offered to take it over. He renegotiated the lease, contracted with health insurance plans and transferred patients’ records to a new electronic medical records system.
Sports Medicine at Chelsea initially had two staff members—Dr. Stark and a billing assistant—but now employs eight other clinicians and additional office staff. “Running a private practice is difficult nowadays, but you are your own boss, and you have a special feeling about your patients because they sought out your care,” Dr. Stark says. “As much as there are stresses, I wouldn’t want to trade.”
Building a new practice
Family physician Chris Larson, DO, entered medicine knowing he wanted to practice outside the fee-for-service model. “I gave up another career to do this, and I didn’t want to work under a practice model where I felt rushed,” says Dr. Larson, who previously worked in investment banking. In 2014, he opened his direct primary care practice, Euphora Health, in Austin, Texas. Dr. Larson supplements his income by working 20-30 hours each week at an urgent care clinic and has built up his patient base through print and Facebook ads, community appearances and word of mouth.
Dr. Larson says the direct primary care model of practice makes good business sense for young practices. “In the fee-for-service model, you have to employ people to work with insurance companies, which multiplies your overhead,” he says. “You’re painted into a corner that requires you to quickly, aggressively see a lot of patients.” In contrast, Dr. Larson’s staff consists of himself and a medical assistant. Patients pay an enrollment fee to join the practice and a monthly fee that allows them unlimited visits, unlimited routine family medicine procedures and low-cost lab work.
Though he acknowledges the inherent challenges of balancing patient care, small-business ownership and a second job, Dr. Larson says starting a practice is an achievable goal for physicians. He suggests buying used office equipment if possible and partnering with small companies to conduct lab testing, as they may offer better rates.
Young physicians may want to delay opening a practice until they’ve had a chance to gain work experience, build savings and get familiar with their community, Dr. Stark cautions. During that time, doctors can cultivate their business acumen by finding mentors and studying how their employer handles issues such as billing and coding, inventory management and marketing. However, physicians considering private practice should carefully examine any noncompete agreements on employment contracts.
Although starting a practice has involved sacrifices, Dr. Larson says the trade-off has been worth it. “My wife and I have two young children—I’d like to be home more than I am,” he says. “But I can build my practice into something bigger than myself.”