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Orthodoc,

I am currently an ortho intern and my wife and I were having this very discussion tonight. I was wondering if lifestyle changes much from residency immedietely after going into practice, or if a practicing physician would have to work for several years (or decades) before the 3 1/2 days per week thing is feasible.

Sorry for the delay. Been skiing in Vail for a few days. Your lifestyle will be determined by your practice selection. So you need to find a group that allows the lifestyle you want to lead. I joined a group that has a full day off each week and that's the way I've kept it since the beginning. If you start heavy and work alot, say five days a week, pretty soon your clinics and schedule are full five days a week and it becomes very difficult to back down. Now, if your only goal is to make money right away, then you may choose to work extremely hard out the gates to get your income up. My philosophy was that I worked hard enough through residency, that it was time to sit back and enjoy my family and let my practice build up with time and not do extra clinics or take extra call. It didn't take long to have full clinics, just a few months, but it took about three years of practice to start having full operative schedules and that was fine with me. Most orthopods will tell you that it takes about 3-5 years to develop a practice. My schedule is two full days of clinic per week usually seeing about 40-45 patients per day and home by 5:30 ish. I also have two full operative days a week, and usually home by 4:00 ish, unless I have a call case to do.

In the begining there is alot of down time b/c you'll have operative days with nothing scheduled, and a few clinics where you are twiddling your thumbs. I would suggest enjoying those times, b/c they will be gone before you know it.

Hi OrthoDoc,
I was wondering what kind of family time one can look at going into a solo practice. Or, am I just kidding myself? In addition, is it feasible to go into solo practice right after you finish residency, or do you need to work in a group for several years to develop your referral base? Your input would be appreciated.

It is very rare to go into solo practice now. I know of only one individual who went directly into solo practice and he is having a hard time getting any block surgical time at the hospital, so he operates late afternoons, nights, and weekends. He also gets some stuff dumped on him in the ER. I think if you went solo in a small town with no orthopod, the hospital would probably do anything for you and the local FPs would probably refer to you, but if you try a solo practice in a major town, it will be incredibly hard.

I think the hardest part of orthopedics is the business side, which most of us have absolutely no training in. I had no clue how billing, coding, scheduling, etc...was done and after four years, I'm still clueless on a lot of things. This things would make solo practice hard unless you buy someone out who has an experienced office staff.

The other downside to solo practice is being on call all of the time, unless you find some other orthopod or group to share call with. Everytime you leave town, you must arrange for someone to watch your patients and be available for phone calls.

Also, with solo practice you don't have any experienced partners to bounce things off of in clinic, or help you out with difficult cases.

As for developing a referral base with a group and then going solo: This is very difficult since most contracts will have a "no compete" clause excluding you from the surrounding market areas unless you pay some ridiculous penalty. Although, you may battle this and win in a court room. However, the money spent on lawyers may bankrupt you.

These are just my thoughts, maybe others out there will shed a more optomistic light on solo practice.