January 8, 2013


I've been terminated from a large hospital system.  I am allowed to keep my privileges and can bring my cases to the hospital, but as of the end of the month I am no longer an employee and will not have an office or anything.  I may want to go into private practice.  What do I have to do?

Dr. S


Dr. S, you are not alone.  I have heard of numerous physician firings in the past few weeks, mainly as a result of lower than expected revenue generation.  The fact that you have kept your privileges or that they are not being challenged is a testament that your services rendered were most likely appropriate, and that the hospital is ready and willing to have you to continue practicing there.  The hospital, however, is apparently no longer willing to guarantee a salary for you.  Next steps are tough.  I applaud your entrepreneurial spirit longing for solo practice, however, accomplishing same from hospital employee to solo is a difficult bridge to gap.  You should start by working with your healthcare attorney and your accountant to determine whether you are in a financial position to embark in solo practice.  You may also want to reach out to a bank to discuss financing, which mainly is available for healthcare practitioners.  After determining finances, an early step will be to determine whether you would like to form a corporate entity to practice under.  Next, (and early on) you should tackle the credentialing process, which may take several months and must be taken care of prior to being able to bill for services rendered to third party payors.  After formation and credentialing have been handled, another early issue is space - where will you be practicing?  And, what support will you have in practice.  You will need assistance with administrative work as well as potentially professional assistance.  Additional legal work to be faced are appropriate HIPAA forms for patients, compliance documents for the practice employees as well as patients. 

Going from hospital employee to solo is not insurmountable.  But, you may take from the above that there is much to be done that may be overwhelming for some.   A more feasible option may be approaching the health system you are leaving to determine whether there is another relationship available for you there.   Maybe the health system will offer a license arrangement, whereby you can rent space, personnel and equipment from the system so that you may remain in the same office, with the same admin and professional support.  Oftentimes this is an option where you are not being terminated for a care or personality issue, but failure to meet financial goals for the system.  Reason being, in a license arrangement, the hospital system would be paid by you, a flat rate, for use of their services.  The health system would no longer be guaranteeing you payment, you would be guaranteeing them payment now.  Tables have turned.  And, the health system is still getting your procedures.  If licensure is not an option, you may want to explore employment elsewhere as opposed to take the risk to move to solo practice.  If you are up for the challenge, there are absolute benefits for being your own boss, first one being you will not be fire-able!