This is the classic style of medical practice in which a new physician "hangs up a shingle" and builds and runs the practice him or herself. The physician is responsible for bringing in patients and administrates what is usually (though not always) a small staff of clerical personnel who do the billing, collections and scheduling. The physician may also employ a nurse or a physician assistant, nurse practitioner or other allied health professional. As an employer, the physician is faced with multiple issues, particularly compliance with employment laws regarding discrimination, pay, taxes, benefits, etc.

The good news, and why physicians still find solo practice rewarding, is that you "call the shots." Solo physicians decide how they wish to practice—the types of patients they will see, the hours they will work, who they will employ, what payers they will contract with and, most importantly, how they will treat patients. Of course, there is no question about income—whatever you earn after overhead, you keep, so solo physicians are in control of their economic destinies.

Solo practice therefore is the most autonomous style of medicine available today. One downside, however, is that even the most autonomous style of practice is not truly autonomous today. If you contract with managed care companies or see Medicare patients, you will not be able to set your own fees. Also, if you contract with payers who impose treatment protocols you may not be able to make clinical decisions autonomously. And as a solo physician, your time may not be your own because you may be obliged to be on call most of the time and you may be doing a lot of the paperwork.

In short, though autonomous, solo physicians are often more "married to medicine" than are physicians working in other settings. This can be a good or a bad thing, depending on your perspective.

Solo practice tends to be a better option for entrepreneurial physicians who are not daunted by the prospects of running a business. In addition, solo settings are generally more prevalent in rural areas where there may not be enough physicians in particular specialties to form groups.

PARTNERSHIP

Another small and fairly autonomous style of practice is partnership. Some new physicians go directly from residency to join an established physician as a partner. It's not uncommon for physicians to join fathers, uncles or other relatives as a partner.

In a partnership, physicians share assets and overhead cost and agree on a distribution of practice income. Each physician keeps what he makes after he has paid his share of the overhead, and each has an equal share in how the partnership is run.

When the relationship is amicable, partnerships can be a very favorable practice setting, because you get the support of a partner while also enjoying a good deal of autonomy. The key, obviously, is finding the right partner. In all types of business, not just medicine, you will hear horror stories about partnerships that went wrong. The analogy, overused but true, is that partnerships are like marriages. The association can be so close that it becomes grating—minor disputes get magnified and what started out positively goes bad.

You probably would not marry a stranger and the same principle holds true for a partner.

ASSOCIATION

An association is another small and relatively autonomous practice style. In an association, two physicians share office space and assets but do not share books. Each physician keeps whatever he has earned after overhead and each physician acts like a solo physician in terms of who they hire, their hours, how they run their practice, etc.