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Working in an independent practice vs a large clinic setting

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Entrepreneurship is a life’s dream for many people. A person who is able to launch a business and report only to clients, rather than to a management structure or supervisor, may find happiness and fulfillment in his or her newfound independence. The same may be true for primary care providers who decide they want to practice independently rather than be employed by a larger health care facility. There are advantages and disadvantages both to remaining independent and to working in a large clinic setting.

Challenges and benefits for the independent physician, according to Philip Masters, MD, FACP, writing for the American College of Physicians, include:

Practice management. An independent physician is ultimately responsible for all of the administrative tasks involved in operating and maintaining the practice.
-Hiring staff. Such tasks cannot be handled alone, so the independent physician will have to recruit, hire, and retain quality staff members who can assist with patients and with administrative duties.
-Billing, keeping up with regulations. The shift to value-based payments and the continuing debate over health care coverage will impact the independent physician’s practice in regard to billing and maintaining compliance.
-Ensuring the integrity of protected data. HIPAA regulations apply to all protected health information, including electronically maintained data (ePHI). Independent physicians who take advantage of electronic health records (EHRs) must adhere to HIPAA regulations as well.
-Developing closer relationships with patients. The independent physician has the opportunity to get to know patients more fully in a smaller practice.

Likewise, there are challenges and benefits for the physician working in a larger clinic:

-Reduced administrative burden. Most clinics are fully staffed with personnel assigned to patient services and administrative duties.
-More resources for coverage. Clinics generally employ more than one primary care physician, so backup is available.
-Lack of control. Dr. Masters points out that “scheduling and productivity expectations may be beyond your control, and policies and procedures may be developed by others without your input” in a clinic setting.
-Other expectations, beyond providing for patient care. A clinic may expect its physicians to participate in committees or other activities within (and outside) the organization.
-Business-like structure. Larger clinics are often focused on making money. The independent physician who is more focused on patient outcomes may find this a challenging adjustment.