Breaking the isolation of the solo practitioner

Staying connected can overcome the potential pitfalls of going it alone.

By Salim Butrus, MD, Rana J. Mady, MD

Imagine this scenario: When starting in solo practice, a patient presents with a severe soft contact lens-related central corneal ulcer. She slept in her lenses and basically abused them, and you feel an urgency to treat her condition to avoid corneal perforation or loss of vision the moment you see her. You need to perform an urgent gram-stain and corneal scraping with culture and sensitivities. In addition, the patient requires fortified antibiotic drops, which are not commercially available at local pharmacies and have to be prepared at an in-house hospital pharmacy. And, in a solo practice setting, you may not have access to culture medium or have the time to prepare fortified antibiotics.

Despite facing these obstacles, being a solo practitioner offers many advantages, including the independence and flexibility you cannot find in an employed setting.

Though being your own boss offers a sense of job security and control, running a successful solo practice comes with unique challenges, not the least of which is not having daily contact with a fellow ophthalmologist.

Here, we outline some of the hurdles associated with this rewarding career choice and how to overcome them.

ISOLATION

Where’s the help?

Practicing within a group setting creates an environment of collegiality and allows for easy exchange of ideas, which can be invaluable in certain clinical situations in which a second opinion can be crucial.

However, physicians who practice alone can become quite detached, particularly in more remote or rural settings. Managing complex clinical cases without the resources of nearby academic institutions or subspecialists can become daunting for the practitioner and the patient.

Solo practitioners may need to provide services they are not comfortable with or utilize resources that may not be available, such as dealing with a patient with diabetic retinopathy who needs pan-retinal photocoagulation. The patients’ alternative may be traveling long distances to receive these specialized services.

Making long-distance connections

Technology offers innovative solutions to overcome isolation. HIPAA-compliant social media sites and free online medical networks allow physicians to instantly communicate and exchange secure messages regarding patient care, including clinical images, expert consultation and coordination of care and collaboration anywhere in the United States. If necessary, they can send and coordinate referrals.

Staying current

In addition to professional isolation, academic isolation can make it difficult for the solo practitioner to stay current with rapidly changing techniques and emerging technologies and therapies. The pressures of maintaining a solo practice often prohibit taking time to attend conferences or acquire new surgical skills. These academic activities are often allowed and encouraged when practicing in large groups and in hospital or managed care settings. Keeping up with trends can be challenging without these opportunities.

Despite these limitations, several resources are available to help physicians remain current. The AAO has resources to help practicing ophthalmologists stay up-to-date on advancing techniques and new treatment regimens and options, as do a variety of publications and websites. Its Ophthalmic News and Education (ONE) Network provides continuing education via online access to major ophthalmic journals, multimedia tools, up-to-date guidelines, statistics, self-assessment tools and CME modules.

Along with online tools, some solo practitioners may consider taking a few days away from the practice to acquire a new surgical skill. If the community has a growing need for this skill, the short-term financial loss may translate to long-term gains for the practice and allow the physician to better serve the community.

MANAGERIAL DUTIES

Learning business skills

Maintaining a well-managed, successful practice also requires strong business skills. Unfortunately, these skills are not adequately taught in medical school or residency. With reimbursements declining compared with our costs and a constant uncertainty regarding legislative changes affecting reimbursements, being business savvy is absolutely necessary to survive and thrive financially.

Though most physicians who start a solo practice have an innate entrepreneurial spirit and willingness to take risks, many may not have the training or skills needed to get the business started. Along with online articles containing advice on starting a solo practice, the AAO has a dedicated practice management resource, the American Academy of Ophthalmic Executives, that can guide physicians embarking on this journey. Its website provides resources for physicians as well as administrators, billers and coders, along with a directory of medical practice management consultants.

Word of mouth

Another invaluable resource: Speaking to ophthalmologists who have established a solo practice. Many ophthalmologists who have managed successful businesses have learned valuable lessons the hard way and can share these experiences. Moreover, friends and family members with experience in real estate, finance and law can also offer professional and financial guidance.

BALANCING WORK AND LIFE

Managing the office

Maintaining a work-life balance can be difficult when you spend most waking hours in the office — a time commitment particularly true when you’re starting a practice. Volume drives financial success in a solo practice, so physicians must remain busy in the clinic and operating room. This can mean working after hours to deal with the managerial aspects of running the practice. Moreover, being the sole provider in the office can require on-call demands, so arranging coverage for days off can be problematic.

Solo practitioners can spend less time in the office by hiring an experienced or well-trained office manager. Though this is an additional expense, an office manager significantly reduces the burden of overseeing the practice and allows for more time to focus on interests outside the office or family life.

Cloud-based systems

Physicians who desire to spend more time at home with their families could acquire a cloud-based EHR rather than a client-server system. This allows for secure access to patient records anywhere via an Internet connection. You can complete charting or review medical records from home after spending time with the family.

Though this does not reduce the workload, it allows for a flexibility that previously was unavailable through paper charting and client-server EHR. In addition, the lack of server, hardware and software installation may make cloud-based EHR more affordable and easier to implement in a solo practice setting.

Splendid isolation

Practicing solo in ophthalmology is becoming increasingly challenging, and can present even more difficulties than those we’ve discussed here. However, with advances in technology and social media and a well-researched business plan, ophthalmologists can overcome these challenges.

Running a solo practice is greatly rewarding if armed with the resources needed to surpass these limitations. OM

About the Authors
	Salim Butrus, MD, (top) is in solo private practice at the Eye Center on Capitol Hill in Washington, D.C. He is affiliated with Georgetown University Hospital, where he teaches, conducts research and performs complex procedures. His e-mail is sbutrus@verizon.net.
	Rana J. Mady, MD, is completing her final year of ophthalmology residency at Georgetown University Hospital/Washington Hospital Center. Her e-mail is rana.mady@gmail.com. Disclosure: Drs. Butrus and Mady have no conflicts to disclose.