Radiologists in Private Practice

September 15, 2016

This series focuses on what it’s like to be a radiologist in a variety of settings. Here, we focused on private practice radiology.

It’s an iconic image for a young child who wants to be a doctor someday – that sign on a building that announces he or she is available to see patients. For many, being that solo physician is a dream they chase for years.

After finishing residency, not every new radiologist wants to stay close to academia. Many opt to strike out on their own, either launching a solo practice or joining an existing practice of any size. Instead of devoting time and energy to research and teaching the next radiological generation, you’re focused on using your skills to provide the best patient care possible within your community.

According to Stefano Bartoletti, MD, clinical director of radiology at the Children’s Hospital of Pittsburgh, private practice offers practitioners a great amount of leeway, but its safety net is small.

“Private practice allows significant involvement on the part of radiologists managing their own practice and being involved in the decision-making that will shape a group in the future,” he said. “However, this involves some degree of risk taking.”

Given that a private practice option offers less shelter than the umbrella of an academic institution, there are characteristics anyone considering this route should consider.

Benefits
The ideal of being a doctor in private practice wouldn’t be popular if the career option didn’t offer upsides.

1. Choice of focus: Many private practices do offer some flexibility in how radiologists can choose to focus their time. Even though a significant portion of a provider’s time will be spent reading a myriad of studies from various specialties, it is possible to carve out a niche and grow your business in your chosen subspecialty area within the practice.

2. Face-to-face relationships: Working in the same environment on a daily basis with the same people offers you the opportunity to create strong partnerships within your group.

3. Personal service: Simultaneously, working in a practice opens the door for you to interact frequently and directly with the referring physicians who send you their patients. Building these relationships helps secure your future financial stability.

4. Greater latitude: New radiologists are frequently attracted to private practice because the path offers greater autonomy and greater schedule flexibility. In addition, compensation is often higher than in academia. According to the Association of American Medical Colleges Careers in Medicine Survey, starting salaries are approximately $285,000.

Having such close working relationships with both in-office colleagues and referring physicians will make your day-to-day work flow easier, said Brandon Selle, practice administrator for Northeast Missouri Imaging Associates. It can build your reputation as a highly-respected provider in a private practice upon which they can depend.

Challenges
Although many new radiologists view private practice as a career filled with autonomy and higher-than-average salaries, this professional path does present some challenges, according to Selle.

1. Physicians, not businessmen: First and foremost, you selected medicine – specifically radiology – as your career because you wanted to help people who had health concerns. Being in private practice, however, often calls on you to think like a business owner. You have to think about expenses, salaries, and reimbursement. In most cases, you weren’t trained to handle these issues, and they monopolize time that you’d rather be spending with patients and referring physicians.

2. Cutting-edge costs: Unlike academic radiology where universities help departments meet the mandate of staying on the leading edge of technology as they teach students and residents, private practices must fund equipment purchases on their own. As a solo practitioner or member of a small group, the cost of acquiring the latest equipment can weigh heavily on your bottom line – and in some cases, it can be cost prohibitive.

3. Insurance negotiations: Just like hospitals, private practices must come to an agreement with insurance providers on what their reimbursement rates will be. If you’re in a larger practice, you could be in a better position to negotiate favorable reimbursement rates, but that’s harder to do if your practice is smaller or if you’re a solo practitioner.

4. Recruitment: As health care moves toward greater subspecialization, attracting new radiologists to private practice where they’ll spend a substantial portion of their time as a general radiologist can be challenging. Young providers typically look to focus their efforts on a specific area.[[{"type":"media","view_mode":"media_crop","fid":"51966","attributes":{"alt":"Private practice radiology","class":"media-image media-image-right","id":"media_crop_233604750097","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6431","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Aha-Soft/Shutterstock.com","typeof":"foaf:Image"}}]]

Social Media
If you’re a provider interested in meeting patients where they live in the Internet, selecting private practice could help you maximize the most commonly used social media tools. Facebook, Twitter, Instagram YouTube, and LinkedIn are frequently used to publicize practice names and advertise the services each group provides.

Based on the results of a May 2015 Journal of the American College of Radiology study, private practice groups outpaced academic groups in their use of social media platforms to reach patients. The study, which looked at 50 private practices and 50 academic groups, revealed 76% of private practices and 28% of academic practices actively used at least one social media account. Results also showed private practices launched Facebook accounts 12 months and Twitter accounts 18 monthsbefore academic groups.

“Use of social media in health care is emerging as mainstream with private radiology groups being early adopters on Facebook and Twitter in comparison with academic radiology groups,” lead author Glover McKinley, MD, a Massachusetts General Hospital radiologist, wrote. “Competitive environments and institutional policies may be strong factors that influence how social media is used by radiologists at the group and department levels.”

Reimbursement
Private practices follow the same Medicare fee schedule as academic radiology practices, and they frequently take on cases that are less complicated than those referred to tertiary or quaternary environments. Instead, the majority of reimbursement comes from volume.

However, reimbursement cuts and a shift away from the fee-for-service model have started to impact private practice’s financial strength, said Ben White, MD, a radiology resident at Harvard Medical School.

“Private practice radiology was well suited to the era of fee-for-service medicine,” he said. “In a future of more capitated and ‘value-based’ health care, there will be more contraction and consolidation.”

Mergers & Acquisitions
The growth of consolidation within the industry is real, said Gregory Connor, MD, a private practice radiologist with the Austin Radiological Association, and many in the industry fear they will soon be forced into larger groups simply to secure future employment. This perception, he said, exists because providers believe increased commoditization makes the survival of smaller groups uncertain, and they’re concerned their skill set will no longer been seen as unique and distinct within health care.

Despite the irreversible trend that binds practices together in larger forms, private practices should feel confident they’ll be able to maintain their distinct identities.

“There’s concern that large groups that are too big to fail will be the future scenario,” Connor said. “But, I think we may work together more collaboratively underneath larger and large business entities, and our local level of service will still take precedence when there’s a question of the value we add to health care.”

While smaller practices have a strong chance at survival, you should be aware of any large, diverse groups looking to move into your geographic area, said Rick Cooper, JD, a health care attorney with McDonald Hopkins.

“As for individual practices who aren’t interested in merging, the biggest risk or danger is having a large, well-funded, well-managed, geographically- or subspecialty-diverse practice come into your area,” he said. “They can try to capture your referral sources or hire away your providers.”

Overall, when the benefits and challenges of private practice are weighed, the career option still emerges as a strong one. Radiologists in private practice are still making healthy salaries, White said, but their take-home pay is lower than in previous years. Consequently, the pressure to read an ever-increasing number of studies is significant.

Although providers in solo, small, or large private practices face unique challenges, they’re still well positioned to play a large part in strengthening the role radiologists will play in the new health care environment, said Sanjay Jain, MD, editor-in-chief of the Indian Journal of Radiology and Imaging.

Private practitioners spend significant time meeting other providers’ needs. Doing so creates a strong, loyal referral base and assures referring providers that radiologists bring value to the table in a team-based care environment.

Because success is based on speed and competency – and because clinical study volumes will continue to grow – solidifying that level of trust is paramount.

To reach that level of accomplishment, though, Connor said, you must be willing to consistently invest in yourself.

“Your training isn’t done when you go into private practice, and I think people underestimate that reality,” Connor said. “You’re still responsible for continuing your education for the rest of your career. That’s the only way to be successful in private practice even if it is more challenging because you have to take the responsibility on by yourself.”