In the current landscape, are solo practices economically and operationally viable?
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Autonomy in solo practice
There are many viable operational models to thrive in modern health care.
My personal choice was to create a vision correction institute starting as a single surgeon. This is common when founding a practice, and in fact, most multi-surgeon practices were founded by a single practitioner. I am the only surgeon in my practice, but we have multiple medical providers who oversee perioperative care and evaluation.
The benefits of a single-surgeon-based practice are numerous and include nimble decision-making, which has led us to rapid evolution in the everchanging landscape of eye care. Our vision of focusing the client experience with comprehensive offerings for surgical vision correction, with a primary focus on presbyopia, was well suited to a contemporary solo practitioner. And I had the autonomy to design and develop my project consequently. Because there were fewer people involved, we were also able to rapidly adopt innovative marketing practices and methods to stay on the cutting edge of our equipment, research and development and to optimize the brand, which our clients have come to trust over the years. Being small encourages more personal relationships and easier interactions, and we all work within a unified mind, vision and values, providing high-quality value-based care.
In addition, although the economies of scale can be realized perhaps more efficiently with more surgeons, we also have the ability to streamline our overhead with a single-surgeon practice because there is less staff required.
Like with everything in life, there are trade-offs. First, we do not have the redundancy for surgery in the system, and if I am out of the office, we can still function operationally but not surgically. Second, there is a point at which, by having multiple surgeons, the relative overhead starts to decrease because the revenues increase, and you can share resources. Last, although we have an extraordinary fellowship in our team, we lack the peer-to-peer, surgeon-to-surgeon perspective.
It has been an extraordinarily rewarding experience as the founder of our vision correction institute, with satisfaction of team building, brand building and taking care of our clients. However, I have always seen this as a dynamic situation, and we do have the need to expand to multiple surgeons in the near future.
George O. Waring IV, MD, FACS, is OSN Presbyopia Section Editor.
Strength in numbers
One of the principles of investing is diversification. Putting all of your money into one stock or one sector is like playing poker and going “all in.”
A medical practice is also an investment of sorts. A solo practitioner is concentrating his or her human capital and financial capital in one place, which can be a risky proposition.
Many solo practitioners learned this painful lesson from the COVID-19 pandemic. After shutting down elective surgery and nonemergency care for weeks in 2020 while overhead costs continued to mount, many now find themselves praying that they do not get sick with COVID and have to take time off from work again with another interruption of cash flow. At the same time, furloughing staff without pay risks the loss of talented, experienced team members.
Having evolved from solo to group practice, I know firsthand the many advantages of a group. These include rotating call for the practice, uninterrupted surgical revenue streams when a doctor attends a meeting or is on vacation, cross referral between subspecialties, lower patient acquisition cost, and fixed costs spread over more patient visits, such as IT, rent and overhead. A group practice makes more than one office location economically viable, expanding the geographic reach for patients and referrals. And, as ophthalmology becomes more capital intensive, the cost of expensive equipment and software is shared by the group.
Oftentimes, one sector in ophthalmology is hit harder with Medicare reimbursement cuts than another. Here, there is a significant benefit of diversifying by having multiple subspecialties in the practice, such as retina and cornea. The end result is a more stable cash flow as the practice adjusts to these changes in reimbursement. Moreover, multispecialty groups guard against the loss of a co-managing referral network for specific procedures (eg, LASIK). Finally, at some point in time, practitioners begin planning for retirement and start looking for an exit strategy. In group practices, a legacy plan may already be in place by diversifying doctors according to age. For practices seeking to partner with venture capital, VC typically sees greater value and far lower risk in acquiring group practices, thereby avoiding the potential cost arising from a solo practitioner becoming ill or disabled or being terminated from a prominent insurance panel.
Jay S. Pepose, MD, PhD, is the founder and medical director of Pepose Vision Institute in St. Louis.
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