Independent contracting in ophthalmology: A satisfying path forward
As a board-certified oculoplastic surgeon, I began my career as a full-time associate at a busy ophthalmology practice.
At the time, I was craving safety as I finally stepped out into the “real world” as a full-fledged attending. Over the next few years, the structure that once brought me security began to feel constraining. When I finally decided to make the leap into the world of independent contracting, I discovered all the advantages that this practice structure provides: increased revenue, greater control over my schedule and healthier boundaries that allow me to be more present for my family. Independent contracting is a good solution for the ophthalmologist who wants more autonomy and flexibility while still maintaining clinical fulfillment.
What is independent contracting in ophthalmology?
An ophthalmologist who practices as an independent contractor typically provides services to multiple practices and surgery centers. Instead of functioning as a W-2 employee, the contactor forms their own business entity, typically an S corporation and professional corporation. That business entity then contracts with practices that have a need for the contractor’s expertise. I currently work 3.5 days per week across six practices in the Greater Philadelphia area in my chosen specialty of oculoplastics and aesthetics.
This business model can also work well for other ophthalmology subspecialties. Independent contractors with anterior segment and cornea training can tap into practices that have a surgical backlog of cataract cases or are looking to add refractive surgery. Glaucoma and retina specialists would do well by serving markets in which the supply of expertise does not meet patient demand. The key is flexibility on both sides.
Why I made the switch
After 5 years practicing as an associate, I decided to make the switch to independent contracting not because I was burnt out but because I did not want to become burnt out. I found myself wanting more agency over how I practice medicine and how I live my life. Once I took this leap of faith, certain aspects of employed practice (administrative overreach, on-call responsibilities, rigid scheduling) were replaced with greater autonomy, freedom and flexibility. By building my practice as a mosaic of contracting positions, I created a practice that was truly by design.
Early in my journey, I discovered that many ophthalmology practices have a need and desire to keep their oculoplastics cases in house but did not have enough volume to bring someone on full time. I also discovered that many practices wanted to introduce Botox (onabotulinumtoxinA, AbbVie) and fillers but did not know how. By filling in these gaps, I carved out a unique niche by creatively meeting each practice’s demand. This has allowed me to build win-win relationships with practices that have stood the test of time.
Building a scalable model
In the beginning, I was careful to align myself with high-quality practices that shared my patient-centric values. With the help of my contract attorney, I negotiated rates that reflected the value I felt I could bring to each practice location. By building trust with the other providers at each office, I quickly built a reliable referral base, and now I rarely market myself.
In terms of managing my business, I love having control over financial strategy by operating under my own S corp. I work with my financial advisor and accountant to determine how much salary to take in W-2 wages to maximize retirement contributions to my solo 401(k) and how much to leave in the business for reinvestment or shareholder distributions. I track my collections daily, and whenever they drop, I try to think of one new idea to help grow the business.
During the first 6 months of practice, I was working 7 days a week as the business was getting off the ground. As my practice grew, I set clear financial goals for myself regarding when to cut back. I now dedicate 3.5 days a week to clinical time. This has allowed me time to pursue other professional goals such as serving as a Botox and fillers trainer to beginning injectors and serving as a key opinion leader for industry partners in ophthalmology, oculoplastics and aesthetics. It has also allowed me to spend more time with my family, which is my No. 1 priority.
The trade-offs
There are distinct challenges to practicing as an independent contractor. For starters, I am responsible for providing my own malpractice coverage. I also do my own credentialing such as license renewals, although the practices handle getting me credentialed with each insurance company. There is an increased administrative burden, including using QuickBooks for accounting, working with my legal team to negotiate contracts and maintaining accurate collections at each office.
Independent contracting is not for everyone. You must be highly self-directed. There is no boss, which is great, but you are the one who must solve all your problems. Over the years, I have dealt with late payments from practices, denied ptosis claims and being the “low man on the totem pole” when schedules were limited during the COVID-19 pandemic. Despite all this, I would never go back.
Beyond the clinic: Leveraging flexibility
Time has been the greatest gift that independent contracting has given me. I have used this time to invest in real estate, work with industry partners and serve as a mentor to young doctors. I am deeply committed to my two young children, and I am unapologetic about protecting my time with them.
Independent contracting has also given me the freedom to build my ideal practice. As I have grown, this freedom has allowed me to phase out more complicated cases (orbital reconstruction, dacryocystorhinostomy) as I focus more on the ptosis repairs, blepharoplasties and injectables that I love.
Advice for others
To get started as an independent contractor in ophthalmology, first consult with an attorney to help create a business entity and a contract attorney to help negotiate initial contracts. Next, build relationships with local ophthalmology and optometry practices and ASC administrators, especially those with gaps in your specific area of expertise. Simultaneously, make sure you understand your numbers. What monthly revenue would you need to exceed your personal expenses? What are your overhead costs (malpractice coverage, legal, accountant, financial advisor)? What are your short- and long-term financial goals? As you grow, make sure to protect your time and maintain healthy boundaries. Setting them is the easy part, but they only work if you maintain them.
Independent contracting is not everyone’s cup of tea. But it can be a deeply rewarding path for those of us who crave autonomy, flexibility and efficiency without sacrificing patient care.
For more information:
Paul B. Johnson, MD, can be reached at johnson.paul.b@gmail.com.
Sources/Disclosures
Source:
Expert Submission
Disclosures: Johnson reports no relevant financial disclosures.
Ask a clinical question and tap into Healio AI's knowledge base.
- PubMed, enrolling/recruiting trials, guidelines
- Clinical Guidance, Healio CME, FDA news
- Healio's exclusive daily news coverage of clinical data
Read more about
