Reflections on a Decade of Solo Practice

After nearly 30 years of education, residency, fellowships, and more, I found myself waking up on Monday mornings not wanting to go into work. I had spent many years dedicated to my training and education, including a fellowship at Emory Eye Center that I loved, but the “real world” was not living up to my expectations. I didn’t feel inspired or fulfilled. After six months of working at a group ophthalmology practice, I realized I needed more control over my career – I wanted to be my own boss. I have always had an entrepreneurial spirit, and I knew I would not be satisfied until I took the leap and started my own ophthalmology clinic. Fast forward to the present day, and my solo practice – Lotus Vision – recently celebrated its 10-year anniversary.

The decade-long journey has not always been easy. It took hard work and perseverance to get the practice to where it is today. I have come to believe that my combined medical degree/master of business administration (MD/MBA) at the Tufts University School of Medicine ultimately made me into both a better doctor and a better businessman. But I also gained important skills from my education and experience over the years. In short, I feel I was well prepared to combine my passion for ophthalmology with my mind for business. Nevertheless, building a successful practice from scratch comes with many challenges and lessons must be learned (sometimes the hard way). Fortunately, the “lows” are countered by numerous proud moments.

Before we begin, note that going solo is not for everyone. A survey of thousands of US-based physicians conducted by The Physicians Foundation found that the number of solo practices is decreasing, down from 24.9 percent in 2012 to 17.9 percent in 2018 (1).

If you do decide to take the leap, it helps to know some of the challenges you may face, as well as how you can effectively work through them; I hope you can benefit from the knowledge generated from my own experience.

Challenge one: physician, CEO, marketeer, and more...

Not only do solo practice physicians have to offer quality care for their patients, but they also need to lead all efforts including marketing, practice management, human resources, Merit-based Incentive Payment System (MIPS), technology implementation, and much more. Trying to wear (or at least balance) multiple hats, when paired with inadequate technology, continues to be one of the leading causes of physician burnout, which is exacerbated in solo practices.

For your practice to have longevity, you must minimize your chances of burnout, including taking proactive steps to invest in the right people, processes, and technology. The combination of the right staff along with well-designed technology solutions, when implemented correctly, can help automate time-consuming and administrative tasks.

Challenge two: missing out on the benefits of group practice

It’s intimidating to start your own practice, particularly without a sense of financial or job security. In fact, more practices have been merging in recent years, creating larger practices that, among other benefits, offer physicians more security. I originally joined a group practice out West for this same reason.

When on your own, it is even more important to stay involved on a national and community level with what your peers are doing not only in medical practice but also in the management of clinical operations. By attending national meetings and local physician lectures, I stay ahead of what is trending in practice patterns and new technologies. In addition, by attending the city and state ophthalmology meetings and maintaining friendships with colleagues in the area, we are able to help each other run practices more efficiently.

Challenge three: keeping up with regulatory shifts

Regulatory standards are always evolving, and it is nearly impossible to keep up with them manually. Often, established group practices have staff that are dedicated to keeping up with these shifts, making it easier to stay compliant.

Opt for a vendor who, along with forward-thinking technology, is equipped with professionals to help advise you on upcoming changes (one good example is MIPS). Whatever the challenge, you should feel as though the health IT vendor you work with serves as an extension of your team. 

Challenge four: patient demand for technology

Patients seek doctors who use the best technology. It can help them feel their doctor is in tune with current trends – in tech and in medicine. Of course, implementing new technology can demand significant investment of money and time – both of which are lacking in solo practices (and especially those that are new!).

If you can, invest in a cloud-based electronic health record (EHR) that does not require investment in local servers and is customized to your specific practice and workflow. Find a company that is always innovating and updating its products. Choosing the right technology can make your life easier and help establish trust among your patients.

De-risking with technology

It is no secret that being a solo practitioner is difficult. However, as the owner of a successful solo practice, I know that the above four challenges are not insurmountable, and there are strategies you can take to overcome them. In particular, I’d like to focus on the role of technology.

Despite the hurdles the economic recession was laying at my feet, I found that arming myself with the proper technology and tools helped streamline my business operations, and ultimately, helped me flourish. The key was to be humble and respect the process – opening the clinic with just the essential technology, staff and office space. I gradually introduced new equipment and additional team members as the practice grew and evolved. In an era where healthcare continues to consolidate, ophthalmologists are rather unique among medical specialties in that solo practice is still a viable pursuit. Although it amplifies the need for an efficient business model, a successful solo ophthalmology practice can be achieved with the right mix of hard work, tenacity, courage, and technology.

What tech does your practice need?

When I first started my practice, I wanted to have a paperless office, but because I did not have the capital to invest in an ophthalmology EHR platform at that time, I started with a free system. I quickly found that those sorts of general-use EHR systems are heavily dependent on the user inputting data. I found myself spending a lot of time after clinic hours manually entering notes. The solution was manageable for a time, but with increasing regulations, I knew the workaround could not suffice forever.

A new solution became an even more pressing need in 2014, with the imminent transition to ICD-10. I knew I needed a better and more user-friendly system so I decided to make the jump and implement Modernizing Medicine’s EMA – an ophthalmology EHR built by practicing ophthalmologists.

Firstly, I preferred the ophthalmology-specific nature of EMA over the general technology of other systems. In practical terms, it means the system interface populates with complaints relevant to ophthalmology patients and suggests diagnostic codes, eye exam findings, counseling procedures, and billing requirements. Secondly, I found the platform’s design and ease of use to be incredibly important. When you’re using a technology in your daily workflow, you want to ensure that it knows how you work and facilitates navigation.

When selecting software, ask yourself: will this help my practice grow? Look for a platform that helps streamline tedious tasks and improves efficiencies. Patient history is a vital part of most exams, but this seemingly simple task can become time-consuming without the right system in place. Having a platform that may be used to help ask questions relevant to the purpose of the visit has made a huge difference. When I enter the exam room, I know in what order the visit will unfold and that my EHR will be there to back me up, allowing me to spend more face-to-face time with my patient.

I knew another huge hurdle for me would be keeping up with the evolving regulations. To my surprise, it is possible to stay compliant and keep up with regulations with the help of the right technology. A major concern I had with the ICD-10 changeover was how it would affect billing. However, by choosing a platform that worked for me, it was easy to generate a superbill based on the criteria from the patient’s office note. Once the note is finalized, the information is sent directly to the practices’ billing department, helping to save time and improve overall efficiency in the clinic. MIPS is one of the more recent large-scale changes. Some EHR systems can gather your MIPS reporting data without adding additional time and clicks to your workflow.

Lastly, as a solo practitioner, you’re always on the go. You continuously move around to different doctors’ offices, meetings, and hospitals, and need to make sure your technology can keep up. My best piece of advice is to make sure patient information is accessible on a mobile phone and/or tablet. When you’re traveling and a patient calls late at night, a cloud-based system allows you to answer questions, and refill a prescription instantly.

Jumping in

As I reflect on my past decade as a solo practitioner, I know taking the time to invest and implement proper technology has made all the difference. I view being efficient in the clinic and improving care delivery as synergistic: efficiency affords me the ability to spend more quality time with patients.

Whether you’re a new physician or a seasoned doctor, it’s important to know it is possible to resist joining a large practice to pursue your own dreams. You can achieve financial security and a work-life balance on your own if you arm yourself with smart investments. To me, the business of ophthalmology and the art of caring for patients are inextricably linked. With more efficient clinical operations, I have more time for patient care. And when I focus on quality care delivery, I fulfil my personal and professional mandate. You can, too.