Do You Own a Medical Practice? This Is for You!

One common question I often got as a physician was, "Do you own a private practice?" or some variant of this. It was as if ownership was the epitome of a physician's life—the VIP owners club... of course, I’m being sarcastic. I’m not saying everyone’s experience was like mine, but clinic owners often say the same thing behind closed doors—ownership can be the pits. It's one thing to practice medicine, which constantly puts pressure on one's mind, but managing a clinic and being responsible for other people's actions takes stress to the next level.

People say, "Just hire a manager to run it for you." I would look at them blankly and say, "Really?" Who’s to say that a manager is knowledgeable about how clinical decisions impact the flow of the office? Who’s to say a manager understands how medical practices differ from other offices? Who’s to say you wouldn't spend months, if not years, training them? Does the manager still need a manager? That manager’s manager is YOU—the clinic owner, the one with the medical degree, and the one who has to take full responsibility for everything in the clinic.

Here are a few reasons why I don't miss solo ownership:

1. Dealing with Staff: In the practice, this was my biggest overall expense—payroll and all the associated costs of employment. I dealt with staff who sometimes didn't feel obliged to show up on time for their schedule or do the work they had been assigned. I also dealt with timesheets that didn’t reflect the time they started work and the time they stopped, especially when dealing with the extra chatty employee.

I remember too many times when staff who were supposed to open the clinic failed to show up, and I was thrust into the responsibility of more administrative duties while seeing booked patients. Trying to get employees, often much older than me, to do their jobs was too much.

Dealing with people who sometimes thought specific tasks were beneath them, like restocking their work areas, cleaning up after themselves, or having a positive attitude, was exhausting. As the boss, I ensured I didn't ask employees to do anything I wouldn't do myself. It wasn't uncommon to see me with a broom or mop, cleaning up the mess from snow-covered shoes so that someone didn't slip and fall. Some able-bodied individuals refuse to remove wet footwear despite being provided with fresh, clean boot covers. Perhaps I was a bit sassy, but after kindly asking the same person repeatedly to do something, I moped the floor in front of them for the last time. By this point, they got the message.

2. The 24/7 Responsibilities: I once worked in a health system where we were responsible for providing our patients with 24/7 care. It was a professional requirement to provide after-hours care to our patients, and it was considered unprofessional to send patients to the emergency department without first assessing them. Shortly after this became an official requirement, I notified my patients that I was closing shop and moved to a place with after-hour services for the communities. I do not miss unrealistic expectations in my professional world; there was only so much I could take before I called it a day. In life, you have to have that line in the sand. There needs to be a firm boundary that you don't cross. This is essential to protect yourself, your family, and all that you consider dear to you.

3. Hard to Find Patient Coverage: If you have worked in a small town or city, you are likelier to have experienced this. When you work in areas where, on a good day, it’s a stretch to get physicians to work in the area and even harder to get them to stay in the town, finding meaningful coverage so you can take a much-needed break can be a hindrance for many physicians in practice. Then there are the unexpected and unplanned situations that urgently take you away from work.

4. The Crushing Overhead: Everything costs money. From finding strategies to improve practice flow and enhancing patient services—well, that costs money. I remember one year when woodpeckers decided that my Papa Smurf-colored office would make a great home. So, the woodpeckers decided to make holes in my building—to the tune of over $10,000 in damages, not to mention the cost of the multiple creative ways we tried to keep subsequent birds away from the building. If memory serves me, that was the same year the air conditioner and furnace gave us issues, leading to expensive repair bills. I used to live where power outages were too common, so I decided to invest in a generator—which came with its six-figure price tag, plus regular maintenance costs.

Keeping my practice wheelchair accessible was essential to me, but the elevator arrived with its monthly maintenance bills plus the cost of keeping the automatic doors in good condition. These expenses add up—and many, many other expenses ate away at the practice's revenue: staffing (raises and bonuses), mortgage, health insurance, office insurance, phone systems, parking and snow maintenance, EMR costs, continuous training and CME, building maintenance, utilities—the list goes on.

These are just some things I need to catch up on. How about you?

Owning a medical practice may seem like the ultimate goal for many physicians, but the reality behind the scenes is often far from glamorous. The challenges of managing staff, shouldering 24/7 responsibilities, finding patient coverage, and dealing with overwhelming overhead can take a significant toll on your well-being. While some may thrive in this environment, it's essential to recognize that ownership is not the only path to a fulfilling medical career.

Ultimately, the decision to own a practice should be made with a clear understanding of the demands and sacrifices involved. Your health and happiness matter as much as your patients'—never lose sight of that.