Despite a steady decline in the number of self-employed doctors since the mid-1980s, self-employment is not dead by any means. Nearly half the nation’s doctors still work as self-employed clinicians in some capacity. The main difference now, as opposed to 30 years ago, is that new doctors have multiple self-employment options.
If you are a young doctor thinking about life after residency, understand that you do not have to settle for just anything. You can take a salary position at a hospital or group practice if that is what appeals to you. But if you find the idea of being self-employed intriguing, there are choices.
1. Private Practice Ownership
The first form of self-employment is private practice ownership. Under this model, you establish your own practice, build your own patient base, and maintain primary control over the work environment. You decide how many patients you want to see and when you want to see them.
Within this model there are numerous payment choices. You could sign agreements with major insurance providers to accept their reimbursements for patients under your care. The more insurance partnerships you enter into, the larger your patient base can be.
Another option is to offer concierge medicine. A concierge physician typically charges an annual or monthly fee in exchange for unlimited office visits. Some minor tests might also be included in that fee. The primary advantage of going the concierge route is not having to answer to insurance companies. The physician retains maximum control at all times.
2. Private Practice Partnership
The second option is to join a private practice as a partner. Existing practice owners often begin looking for partners when their practices grow large enough to become unmanageable. They bring a partner on with the idea of maintaining growth and eventually selling their share of the practice to the partner when it comes time to retire.
Partnership does have advantages. For example, joining an existing practice as a partner eliminates the need to start a practice from scratch. It pairs the young doctor with a more experienced colleague capable of teaching him the basics of running a business.
The same payment options apply under this model. Moreover, the new doctor just entering the practice will have to live with whatever payment system has already been established.
3. Locum Tenens Contracting
The third option for self-employment is locum tenens contracting. Under the law, locum clinicians are considered self-employed contractors. This is true even when the locum works with a staffing agency to find assignments. The staffing agency simply acts as an intermediary bringing contractor and healthcare facility together.
The primary benefit of this sort of arrangement is that the clinician gets to practice medicine as a self-employed individual without having all the hassles that come with maintaining an office. The locum does not have to worry about hiring nursing staff and office support. He or she doesn’t have to worry about paying rent or keeping the lights on.
The other side of the coin is taxation. Locum tenens clinicians are responsible for keeping their own books and paying quarterly taxes. They are responsible for keeping track of any business expenses that might be tax-deductible. Anything that has to do with taxes is the responsibility of the locum, not the staffing agency or hiring facilities.
Young doctors looking to be self-employed have multiple options. They can open their own private practices, join an existing practice as a partner, or go to work as a locum tenens physician. That is the beauty of practicing medicine in this country. Doctors can choose how and where they want to work.