Editor's note: This article is part of a series on the various practice models that ophthalmologists can choose to work in. See "Academic vs Private Practice for the Ophthalmologist" and "The Growth of a Multi-Location Practice" for more.
"Where do you see yourself 5 years after residency?” I was sitting in the middle of my residency interview for ophthalmology, and the question made me pause. I realized I didn’t have an answer. I had been so focused my entire life on getting into medical school and then ophthalmology residency that I hadn’t even thought of life beyond training. Wasn’t becoming an ophthalmologist and learning surgery enough? What I didn’t know then, but have since learned, is that getting into your desired specialty and perfecting your knowledge and surgical skills aren’t enough to get you the life (or practice) that you want.
Joining a Private Practice
After graduating residency, like most people of my generation, I joined a practice. It was a good experience, and I appreciated being able to work with a mentor and learn to improve my skills as a clinician and surgeon while not having to worry about the business of running a medical practice, including insurance credentialing, managing employees and monthly overhead costs.
However, eventually I needed to move to be with my future husband. I initially looked for similar positions in the area, but nothing was quite the right fit in the location I wanted. As I prioritized my career and life goals while trying to start a family, I decided on my two top priorities. First was a location that allowed a shorter commute so that I could be present for family events. The other was the ability to create an environment where I could practice at the pace and style that I liked. Thus came the idea to start my own practice.
Getting an Assist When Opening My Practice
After I made this exciting but daunting decision, the next step was the reality of figuring out the details. Where do I get office space? How do I get onto insurance plans? How do I pay staff, let alone myself?
While I slowly started tackled each question, I was able to work at my former practice several days a week to keep a steady stream of income. Along the way, I was lucky and able partner with two groups that assisted with the process.
First, I found a wonderful retina group that had a fully equipped office space certain days of the week (while the doctors were at their other satellite offices). This greatly limited my capital equipment costs and allowed me the flexibility to pay rent for just a few days a week and not have the commitment of a 5-year lease, which is helpful when starting a practice because of the initial limited cash flow. This also allowed me to not take on any debt while starting my practice vs. having to take on the commitment of an office space full time, or perform a large office build out including the purchase of major ophthalmic equipment.
Next, I joined Eye Physicians of Florida, a large group of ophthalmology practices based in South Florida. For those who may be considering joining a similar group structure, here are some of the benefits I have seen:
- Insurance. As part of this group, I became credentialed on many insurance plans quickly. The South Florida insurance market is unique, with many plans not accepting new physicians — with the exception of doctors who join a group. In some cases, new physicians can wait years to get on many insurance plans, which naturally limits their ability to see many patients and thus impedes practice growth. By joining EPF, I was credentialed with most major insurance plans within several months, so that by the time I was able to open my practice, I had the ability to see most patients in the area.
- High-level business support. The central business office and C-level executives allowed me to not need as many employees in the beginning while having access to highly skilled executive level people that could help give me invaluable guidance.
- Independence. I was still responsible for building my own practice and creating my own culture and have strived to keep a personal feel to the practice for both patients and staff. Having worked at several other practices previously, I knew the style of care I wanted to offer my patients and the services I wanted provide. I wanted to be able to make the decision to hire the staff I thought were needed and to invest in technology. To help with the culture, we have looked for show a caring, compassionate attitude from staff members as well as a strong work ethic and sense of responsibility from my doctors.
Along with our hard work in providing good patient care, the practice has grown during this journey thanks to our optometry outreach. For the past 4 years, I have also been fortunate to work with an amazing physician liaison. She helps maintain constant communication between our practice and referring doctors. This helps ensure a smooth referral process, improves patient access to appointments and facilitates feedback to the referring doctors.
A couple years after opening my doors, the patient volume steadily increased to the point where I was able to hire more employees and then get my own full-time office space! Being able to see patients at my own practice full time was a critical turning point.
Volume continued to grow with the help of my team, and I have since added an office administrator, two optometrists and three more ophthalmologists.
Conclusion
Starting my own practice really has been a journey, with all of the ups and downs, the victories and frustrations that one would expect. I am fortunate to have had the opportunity to join a large network of ophthalmology practices that allowed me the benefit of economy of scale with the central business office and insurance credentialing, while still allowing me the flexibility and autonomy to set up my own practice from a daily operational perspective.
Most of all, I have learned so much about myself, and human nature, and have also had the valuable opportunity to become a better physician and surgeon while still maintaining priority in my family and personal life. As always, I truly give credit for all the love and support provided by my husband, family and friends in ophthalmology. So many close colleagues have given valuable time in mentorship. Without them, my vision would not have turned into reality. OM
