Dont Be Afraid To Start A Solo Practice

Despite what you read and hear, solo private practice is not dead. Very few private practices fail. If you are a medical student, a medical resident or a dissatisfied physician practicing in a large group practice, go out on your own. You can still hang your shingle and do well.

It is true that the proportion of physicians in solo or two physician practices fell from 40% in 1996 to 32% in 2004. Certain specialties are more amenable than others. Obviously, radiology and anesthesiology would not be appropriate but primary care, pediatrics, dermatology, family medicine, ophthalmology, plastic surgery, rheumatology, Infectious diseases, gI, neurology, surgery, vascular surgery, hematology oncology, and geriatrics to name a few, can all be done, if you understand how to do it. Nowadays, small groups and solo practitioners adapt to a changing environment. They use hospitalists to provide on call hospital coverage, they use purchasing groups to get the best prices on equipment and inventory, they understand how to negotiate insurance contracts, and , best of all, as private practitioners in solo or small group practices, they are their own boss and make more money than their large group counter parts.

For 25 years I have heard naysayers herald the apocalypse of medicine. It is far from true. When I went into private practice, HMO's were going to take over medicine and "physician networks" were going to exclude doctors from seeing patients in certain geographic areas. Nope. Didn't happen. So don't worry. Don't be afraid to take the step into opening your own practice. You won't regret it. Just be prepared.

Liability Reform Proposed in House of Representatives

Georgia Republican Rep. Phil Gingrey, MD proposed a bill sponsored by Lamar Smith R-Texas and David Scott D-Ga to reform nation's medical liability system.

The Health Act H.R. 5 would limit the following:
1. period of time during which plaintiff could file suit
2. limit non economic damages to $250,000
3. require judges to apportion responsibility for judgements in cases with multiple defendants
4. limit the percentage of all damages that could be claimed as legal file.

The AMA and AAD supports it.

This is the most logical bill I have read in a long time. Of course, the lawyers will not let it pass so continued defensive medicine practices will raise cost of medicine for tax payers and doctors will continue to pay exorbitant malpractice fees.

There is an abuse of the lawsuit in America. The mentality of a lawsuit "score" by lawyers and plaintiffs achieved on the backs of doctors trying to help patients in an imperfect world is crushing the delivery of medicine. It is inconceivable to me that any health care reform is not attached to liability reform. This glaring omission is evidenced of partisan politics with health care reform reflecting a continued control of lawmakers but none other than...lawyers.

Physician Signature Rule

CMS plans to rescind the requirement for clinical laboratories to obtain physician signatures when billing Medicare for laboratory requisitions. Labs lobbied hard to CMS to repeal this burden. This was part of the November 29, 2010 Medicare Physician Fee Schedule Final rule. Due to heavy criticism the required implementation was delayed until April 1, 2011. Now it is being completely repealed before ever being implemented. That is a good thing. But....

The real issue here is how much does it cost to continually delay, modify and repeal onerous and burdensome paperwork dreamed up by bureaucrats with little to no clinical experience "in the trenches". Maybe if they listen to the doctors struggling day to day in private practice first, then they would avoid costing taxpayers presumably millions of dollars in "change fees".

The first thing Senior residents and fellows need to do to be ready for private practice

At this point, most senior residents and fellows are thinking about their next move. And, for most, it is joining a group practice or starting their own medical practice.

Private practice is waiting and there are a few critical steps that every fellow or senior medical resident must have in place before they venture out into the real world.

Here are just a few quick bullet points to check off your professional to do list and remember: apply for NPI number, register with PECOS, CAQH, make sure your medical license is valid in the state you will be moving to practice, and apply for a DEA license.

The next step would be interview with professionals that will help you be successful. This includes accountants, board certified health care attorneys, insurance agents, and banks. You should be looking to set up a line of credit with a bank that is familiar with doctors needs.

Watson will change medicine forever

Anyone that watched Jeopardy last week saw Watson handle the best of the best when it came to answering obscure questions in nanoseconds. It was fascinating and scary. Nuance and IBM announced collaboraton on Watson. Healthcare is the most obvious next step. Watson will make a huge difference in diagnostic medicine. Access to a computer that can digest symptoms and instantaneously spit out answers and syndromes, will provide immediate benefit to practicing physicians and to patients.

Watson will not replace the intangible benefit of "healing hands and heart" of a physician patient interaction (at least not anytime soon) but it will immediately even the playing field for patients in remote locations or for those who cannot afford the luxury of the brightest doctors at the best academic centers. If you have ever been sick with a rare set of symptoms, then Watson will help scan millions of data instantaneously to match your symptoms to a diagnosis or at least a set of possiblities.

Medical students will have Watson as a teaching tool and that will also help even out inequalities in teaching.

No one here is saying that Watson will replace the ability of a doctor to interpret a patients symptoms, call for help, or need for intangible emotional care that the best doctors can provide and read into their patients needs. Critics will yell about Watson but they will be wrong. In this case, technology moves forward and will yield overall positive benefits.

Key Provisions related to Medicare and Medicaid Extenders Act of 2020-Physicians get reprieve

In December Physicians averted at 24.9 % cut in their income as a result of a last minute passing of The Medicare and Medicaid Extenders Act of 2010. Here are the key provisions:
1. Replace scheduled cuts with a freeze in Physician payments from 2012 to 2020.
2. Direct CMS to develop an improved physician payment formula.
3. In order to make sure CMS establishes a new formula on a timely basis, the annual reductions could be reinstated in 2015 until CMS establishes new payment.

These major provisions are a step in the right direction but our a "day late and a dollar short" as so much of tax payer money could have been saved if Congress acted on this years ago rather than perpetually delaying the cuts with last minute legislations.

Medical Student loans and Tax Forgiveness

The new tax law provides an added benefit for doctors with medical student loans. If your loan is forgiven and you work in an "underserved" area, you may be entitled to tax free treatment on the forgiveness of the tax free loan. This was not always the case.
In the past, often the trade off of practicing medicine in an underserved areas, albeit rewarding emotionally and intangibly, typically did not create the income to offset the benefit of the forgiven loan. In other words, it was more cost effective to keep the loan and practice where you could make money that far exceeded the amount of the loan. However, in today's changing health care landscape, that is not always the case anymore. So, when weighing your options, the intangible benefits plus the tangible cost benefit of a forgiven loan plus tax free treatment of that forgiven loan, may be enough for some people to actually take advantage of this offer and practice in underserved areas.