Going Solo: Otolaryngologists Share the Benefits and Challenges of Private Practice

Recruitment in Private Practice

Nearly five years ago, Christopher Chang, MD, set out to find a physician to bring into his solo otolaryngology practice in a rural part of Virginia. He’s still flying solo.

Although he’s hired a recruiter, placed ads in publications, and contacted chairpersons and attending physicians of area residency programs, so far, he hasn’t found the right person. Because he can’t keep up with the volume of patients by himself, he’s stopped accepting new patients who live outside his office’s county and the surrounding counties, and no longer accepts certain insurance.

“It’s hard for me to recruit someone as opposed to some of the larger groups that seem to have a much easier time recruiting,” he said. “I think the fact that I’m a solo private practice kind of scares them.”

Finding a physician to join the practice would allow him to lift the geographic and insurance restrictions, and hopefully double his patient volume. Until then, he’ll need to continue to ask area otolaryngologists to cover when he’s away from the clinic.

Meanwhile, at Lakeshore Ear, Nose & Throat Center in the Detroit metropolitan area, recruitment couldn’t be easier.

“We receive applications from numerous excellent candidates,” said Adam Rubin, MD, a vice president with the group. “We’re an attractive practice, as we offer the opportunity to provide subspecialty care, do research, and train residents in a private practice setting. A well-organized large private practice can afford many of the same opportunities as an academic center.”

The practice recently hired four new doctors as other physicians with the group neared retirement, for a total of 18 physicians—16 otolaryngologists, one medical allergist, and one maxillofacial surgeon with a fellowship in head and neck surgery.

A small, two-person practice is about to come into the fold as well, Dr. Rubin said. “We’re going to have 20 physicians soon,” he said. “Practices are actually asking us now to help manage them because they see what we have to offer in terms of stability and infrastructure.”

Paul Neis, MD, at Mountain Home ENT & Allergy, a three-physician practice in northern Arkansas, has been trying to find another physician for about three years. He and his fellow physicians are getting older and have plans to cut back on their patient volume.

A few years ago, he found a candidate who would have been a great match. In addition to the right career interests, the physician was a pilot, just like Dr. Neis and his son. He was in contact with the candidate for six months, taking him out to a steakhouse dinner in Chicago during an AAO-HNS meeting.

“That was probably, at that point in my life, the most expensive dinner I’ve paid for,” Dr. Neis said. But the candidate didn’t end up joining the practice—his wife wanted to be closer to her parents’ home. “It was understandable, but yes, very disappointing,” he said.

With plans to reduce his workload, he and the other physician in the practice will become hospital employees, receiving a salary plus bonuses for extra work, and his son will buy out their share of the practice. The hospital will make payments to help cover overhead at the office. Otherwise, the practice would have been hard to sustain, Dr. Neis said. This way, otolaryngology services will continue to be provided in the area.

Dr. Neis said he wishes young physicians had more awareness of private practice. He once suggested to the state’s only residency program that residents spend some time at his practice during their training. He was told they were too busy at the academic medical center and couldn’t spare the time.

“Nobody is exposing them to private practice general ENT,” he said. “And that’s the biggest disservice that I think is being done.”