Publication Exclusive: Group practice vs. solo practice

CEDARS Debates is a monthly feature in Ocular Surgery News. CEDARS — Cornea, External Disease, and Refractive Surgery Society — is a group of cornea, cataract and refractive surgery specialists, here to discuss some of the latest hot topics in ophthalmology.

As the landscape of medicine continues to change, both new and experienced physicians face the decision of how to manage their practices. This month, Dr. Jai Parekh and Dr. David Goldman discuss the benefits of group practice vs. solo practice. We hope you enjoy the discussion.

Kenneth A. Beckman, MD, FACS, OSN CEDARS Debates Editor

Group vs. solo: I say, go group

Growing up, I enjoyed playing second base and eventually became captain of a baseball team; working as a team player with a bunch of athletes was much more appealing for me than serving up a ball in tennis and winning an individual match — Jeter vs. Federer.

Not much has changed 30 years later. A typical question a graduating trainee or even “midlife” ophthalmologist may ask in these changing times is, “Should I join a group or hang out my shingle?” I would say, “Join that practice!” When deciding which path to take, there are several things to consider, including clinical and financial risk, resource control, market access, average income and lifestyle. The phrase “solo practitioner” may be arcane in the next several years.

Traditionally, group practices enjoy the benefit of greater shared clinical experience and access to information. The practice may be a multispecialty eye group including comprehensive, retina, glaucoma, cornea and oculoplastics. This enables you to better care for a patient and “curbside” your associates as needed. My partner, time and time again, will run a corneal ulcer or difficult anterior segment case by me while I will “throw him” a few nerve palsies that I would rather not deal with longitudinally. With our multispecialty eye practice, we only refer patients “out” a few times each year.

In addition, group practitioners have greater access to more patients than do solo providers. By having a practice with multiple physicians, staff members and even multiple locations, this broadens the scope of the practice and enables a group to provide care to more patients and connect with more referrals. This also assists with tough negotiations with insurance companies on trying to get higher reimbursement rates in an era of the “slow death spiral” in which we are getting paid less per patient each day. Remember, consolidation these days in local markets is inevitable, and as ophthalmologists, we need to be part of the health care system, not outside of it. Group practices have more strength.

On a fiscal note, a recently released Medscape survey showed differences in ophthalmology incomes across America based on practice settings. In ophthalmology, office-based single-specialty group providers earn an average of $325,000 annually, while office-based solo practitioners earn an average of $291,000 annually. In a group practice environment, it is also common for most practices to offer some type of bonus or productivity incentive to all providers.

Finally, one of the most advantageous reasons for practicing in a group practice is the ability to have more control over your lifestyle. These providers will be able to control their hours, vacation and holiday schedules, on-call schedules and general lifestyle choices more than solo practitioners. When working with a group of other physicians, it is more likely that when an emergency arises or you have to change your schedule last minute, one of your colleagues will be able to cover for your hours. When working in a solo practice, you can rely only on yourself, and patients can potentially get frustrated when situations such as this arise.

Click here to read the publication exclusive, CEDARS Debate, published in Ocular Surgery News U.S. Edition, March 25, 2015.