As the number of private practices shrinks, opportunities exist for ambitious physicians

We are excited to be part of this column on private practice issues and would like to take this opportunity to introduce ourselves. As two family medicine/sports medicine DOs, each with our own unique experiences in starting and growing our private practices, we plan to share our perspectives when it comes to the ever-evolving and widespread issues facing private practices today.  

Much like the notable dwindling existence of “mom and pop” businesses across the nation, private medical practices have shown a very similar trend.  While there are several reasons contributing to this snowball effect, there are perhaps an equal number of reasons that this situation presents an exciting opportunity for a select group of ambitious physicians to flourish.   

Patients are looking for options

Notwithstanding the daunting pervasive presence of larger health systems, with powerful and widespread marketing, as well as leverage in negotiating rates, Shared Savings Program, etc., patients and insurance companies are and will likely always be looking for options. As you know, major health systems, while striving to be on the cutting edge in as many ways as possible, are still hindered by the unavoidable politics and “red tape” involved in making decisions, and also are forced to provide various protocols for their providers.

While this does help to maintain a standard of care, it also limits the degree to which physicians can individualize their care and provide various treatments that they think are useful. Furthermore, there will always be a natural hesitancy across the board when it comes to any trends favoring monopolization. 

Through future discussions, our goal is to identify many of the historic, present and future challenges facing private practice, and share various strategies and protocols that can be leveraged to overcome many of these. 

Ask us questions

We would like to answer the osteopathic medical community’s questions about private practice. Please leave your questions in the comments below or email them to [email protected].

Questions we plan to answer in this column

Here’s a brief list of some of the questions we are planning to address in future columns:

1) When starting a practice, is it better to be in or out of network with insurances, or is some combination better?

2)  What are the implications of opting in or out of Medicare?

3) How do you decide how many front desk and other ancillary staff you need?

4) Do you recommend hiring mid-level providers/ACPs?

5) How do you recruit and train your staff?

6) What methods do you suggest for retaining staff and improving morale among employees?

7) What factors do you consider when determining possible raises and promotions? 

8) How do you deal with employees who are not performing at the needed level or employees who are the subject of complaints from patients or other employees?

9) What factors do you consider when deciding on a location, as well as a specific space, type/length of lease, etc.?

10) How daunting is the process of doing your own buildout? How do you recommend or decide on whether to design and build an office from scratch versus renting space in a medical building that is already turn-key?  

Bios

Below is a brief bio for each of us authors:

Clifford Stark, DO

Dr. Stark is a board-certified physician with dual certification in sports medicine and family medicine. He is the founder and medical director of Sports Medicine at Chelsea in New York City, and also the program director for the sports medicine fellowship at Zucker School of Medicine at Hofstra/Northwell at Plainview Hospital. Dr. Stark is also the team physician at Berkeley College in Manhattan. 

Dr. Stark graduated from what is now the Kansas City University College of Osteopathic Medicine and completed his residency in family medicine at Robert Wood Johnson at Capital Health and fellowship in sports medicine at Crozer Keystone. 

In 2002, Dr. Stark joined the faculty at Columbia University’s family medicine residency in Manhattan, serving patients at one of their affiliate sites, a large primary care sports medicine practice at Chelsea Piers. In 2005, this practice was closed by the hospital, and reopened by Dr. Stark under the name Sports Medicine at Chelsea (DBA Sports Medicine at Chelsea Piers during the time the practice remained at that site) while still on the Columbia University faculty. He later moved the practice to the Flatiron/Chelsea area, where the practice continued to grow and add services, including more comprehensive primary care, sports medicine and physical therapy. 

In 2010, Dr. Stark also became the program director for the Northshore LIJ Plainview Sports Medicine fellowship program, now renamed Zucker School of Medicine at Hofstra/Northwell at Plainview Hospital, and in 2019 helped guide the program through the necessary transition from AOA accreditation to ACGME accreditation.  He currently remains at Sports Medicine at Chelsea, where he also teaches fellows, residents and medical students. 

Daniel Savarino, DO

Daniel Savarino, DO, is an established and highly skilled physician with over 10 years’ experience in sports medicine. He was born in New York City and graduated from the New York Institute of Technology College of Osteopathic Medicine in 2005. He completed his family medicine residency at North Shore Plainview, where he served as chief resident from 2007-2008.

Dr. Savarino became the first sports medicine fellow at Plainview Hospital. Afterward, he worked for a hospital-owned practice in North Carolina for one year and continued to refine his skills at a private orthopedic office in New York City. In 2017, Dr. Savarino established his own private practice, Apex Center for Regenerative Medicine, in New Jersey. 

Dr. Savarino is board certified in family medicine and sports medicine and is RMSK certified in musculoskeletal ultrasound. 

Related reading:

For the first time, less than half of physicians are in private practice, survey finds

Considering private practice? Here are 6 things to think about