March 28, 2017
3 min read

Can the solo practice premium surgeon survive in today’s health care environment?

One long-time solo practitioner shares tips on how to succeed on your own.

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Twenty-four years ago, I was completing my third year of ophthalmology residency and already had plans to open a private practice solo in a somewhat rural location at that time outside of Chicago. Even as far back as 1993, it was rare to go solo, knowing the financial risks involved at that time. Most of my colleagues either went directly into a fellowship program or joined a group or corporate practice.

In 2017, with the changing landscape of health care, with the need for electronic medical records (EMR), data reporting in terms of meaningful use (MU), Physician Quality Reporting System (PQRS) and soon Merit-based Incentive Payment System (MIPS) and Medicare Access and CHIP Reauthorization Act (MACRA), and the financial penalties for not following such, it seems nearly impossible to consider embarking on a solo practice career. For those brave premium surgeons who have established themselves as or are about to become solo practice warriors, here are a few survival guide tips that have helped me as I approach my 25th year in practice.

Survival guide tips

1. Establish a line of credit with your practice’s financial institution/bank. The perfect example of when I needed to have this as backup was when I underwent major back surgery/spinal fusion in May 2013 and knew there would be little to no income generated in the practice during my recovery process.

2. Nowadays, implementing EMR is critical to enhance efficiency. I can see at least double the number of patients in a day due to capability of navigating a multitude of diagnostic tests quickly in either cataract or refractive surgery evaluation. The other benefit of EMR is the capability to meet MU, PQRS, MIPS and MACRA reporting much easier than with paper charting.

3. When starting up, consider utilizing a billing service to make it more manageable, but over the years I have done billing in-house, which has become much easier through the billing/administrative component of EMR software programs and clearinghouse efficiencies.

4. Establish a good relationship with a lawyer, ideally on a monthly-type retainer fee, to handle all legal affairs such as employee issues (develop an employee handbook), equipment leasing and purchasing contracts, and building leases.

5. Meet potential referring optometrists and primary care physicians in your area and let them know your availability and flexibility to see patients; continue to have quarterly meetings to update them on the practice and consider an annual CE event as well. I decided not to have an optical when I began my practice, which removed the presumed threat from referring ODs that they may not get their patients back after cataract surgery.


6. Get involved in FDA clinical trials as you grow the practice because this will establish you as a leader in the field and subspecialty you have chosen.

7. When to add another eye care professional to the practice can be challenging based on the volume of patients, OD vs. MD, and the financial burden it could be at first glance. My practice now has the volume to entertain a refractive surgery fellow for a year as we have joined the match for the upcoming year.

8. Consider retirement planning from the beginning. These 24 years have crept up quite quickly, and luckily I had a 401(k) and now a defined benefit plan in place so I can eventually retire from the solo world.

9. Create an internal reporting system for all departments with a monthly requirement to review reports (marketing, billing, femtosecond conversions, recalls, etc.). Never assume all is covered and being completed.

10. Stay current and be involved with meetings (ASCRS, AAO, OSN, AECOS, ACES/SEE) and continuing education. Eventually become a key opinion leader yourself for the next generation to follow in your footsteps.

In the end, “survival of the fittest,” as Darwin once defined in his evolutionary theory, even has its place in the solo world of private practice. Kudos to those companions of mine who embark on this path or have already survived the duration.

Disclosure: Jackson reports no relevant financial disclosures.