Solo practice is under attack.
Governments at every level believe that bigger is better
— and even if it isn't better it gives us more control
so we like it. Michael Decter, chairman of the National
Health Council calls solo practice an 'anachronism.' Still,
it's unlikely to go away. Why? Because many physicians
who've worked in other forms of medical practice think
solo is best. Here are some of their comments.
"I worked for a pharma company
for 14 years. The security was great and I felt that
I was making a real contribution to better outcomes
in Canada. The corporate culture was another thing.
It just ground me down," says a former Mississauga,
ON, corporate medical director.
"I had four wonderful partners.
That is, they were wonderful by themselves. Together
it was something else. Each of us always had a different
idea on how things should be done. In the five years
I practised with them I think the only thing we ever
agreed on was going into practice together in the first
place. After that everything was a battle. I've been
in solo now for nine years. Every morning I thank God
and sing a verse of 'I did it my way,'" adds a Winnipeg
family physician.
"I started with a CLSC (community
health centre) right out of med school and then became
an ER physician. After six years of that I joined a
big group in Montreal's Plateau district. Then I went
back to school and specialized in dermatology. Now I'm
in solo and I like it. Why? Because I'm my own boss.
I couldn't stand always being told what to do," says
a Montreal dermatologist.
DO
YOU HAVE WHAT IT TAKES?
Here are some of the qualities your colleagues say they've
needed to start and stay in solo practice.
• Love your freedom.
Freedom to practise medicine — and run your life
— just the way you want tops the list. Like the
Winnipeg FP and the Montreal dermatologist, for many
doctors the urge to practise on their own is driven
by their independent spirits. Says a Calgary doctor
who's worked both sides of the fence, "I found the controls
and procedures mandated by the group I was with terribly
restricting. It got so I couldn't stand being told how
I had to practise medicine."
• Be a risk taker.
Those who enjoy huddling with their colleagues when
it comes time to make a decision are unlikely candidates
for successful solo careers. Being out there on your
own means you make all of your own decisions, and good
bad or indifferent, you have to live with them. Though
the doctor shortage means that finding enough patients
is seldom a problem, managing the practice and the money
it brings in can be. Renting or buying space, hiring
and firing staff, buying furniture, equipment, supplies,
insurance and the 101 other items that come up in any
practice require skill and a propensity to take chances
with the confidence that everything will work out fine
in the end.
• Keep expenses down.
There are two ways to make money in the medical business,
as there are in any business. Keep revenue high and
expenses low. A London, ON, doctor began a successful
practice right out of McMaster by working the near end
of that equation. "For years my office looked like a
mini version of a Sally Ann thrift shop. That's because
it was. Except for medical supplies, I thought buying
anything new was a sin."
• Hard work. Doing
everything yourself may give you an inner sense of satisfaction
but it's hard work. A surgeon who operates a rural general
practice in central BC remembers her early days. "I
was by myself. No help whatsoever. I did it all. Answered
the phones, booked patients, did surgery, obstetrics,
gynecology, dermatology, my own lab tests, EKGs, the
works. And when the day finally ended I tidied up, did
the filing, vacuumed, turned out the lights and went
home to bed."
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