Perils and pleasures of a solo practice

It’s tough being a solo-practitioner.

Sometimes I yearn to have someone right there to ask for a clinical opinion. In the end, am I glad that I started my own practice? You bet! I love being a woman entrepreneur and a doctor.

I was never exposed to business management in medical school or residency, but I love the challenges that come with managing a business.

Before I even started medical school, I always knew that I needed to be my own boss. Although I was a good worker, I had difficulty following orders and always wanted to lead. In grade school, it manifested as “does not listen to instructions.” In high school, I was labeled as “stubborn.” Fortunately, I come from a family who taught me the principles of working hard, so I was still able to become self-disciplined, despite not being a follower. During residency, my superiors recognized that it was best to leave me alone in the job; the task was always completed.

After I finished residency, I worked at two different healthcare systems: Gouverneur Healthcare Services in Manhattan for four years and Maimonides Medical Center in Brooklyn for one and a half years. Without my experiences there, I would never have been able to establish my own practice. I was able to build my knowledge about outpatient medicine, something that wasn’t too much of a focus during my residency training. I was also able to learn the pearls of billing and coding and what it all meant. But still, I struggled with being an employee. Working for a large hospital or joining a large practice felt too traditional.

I started my own medical practice in August 2006, right next door to my former undergrad dormitory at NYU in Greenwich Village. It felt surreal to start a practice with no patients, let alone having to spend more money in the beginning without really knowing if my practice would ever grow or generate a real income. Right away, I decided that there would be very little paper in my office, and I would bill electronically. This has not only saved many trees, but it has allowed me to find documents, results, and consultations so much faster.

When I initially started, I did everything! I scheduled the appointments, answered the phones, and billed insurances. I never had an answering service but made patients aware that if they left a voicemail with an urgent issue, I would be monitoring messages during off hours. Most of my patients have respected this and have not called during the early or late hours unless absolutely necessary.

I also made sure to seek out advice from my predecessors. A mentor from medical school, who has been in practice for over 40 years, told me to make sure I had good doctors who would provide coverage for my practice. That was great advice, as I am able to have personal time, and the call schedule is split evenly and fairly. I also made sure to have coverage doctors who have a similar practice to mine, that is, a fairly younger patient population. This means that we rarely have to go to the hospital to see patients.

One piece of advice I have for anyone who is interested in starting her own practice: invest whatever money you make in the beginning right back into your practice. I did this by upgrading my electronic medical charts. I eventually hired a full-time assistant who now takes care of most of the secretarial and administrative duties. I moved into a space that I was able to make into a serene environment.

It’s a practice I’m proud of – and it’s mine.

Other Resources

Starting a medical practice: one physician's story.

Doctor's discussion forum.

About the Author

Dr. Mandal is a solo-practitioner in New York City.

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