The money on the table was attractive. It was more than I had ever dreamed of. In the past, I had thought of selling the practice and riding off into the sunset. The delivery of medical care was changing, and most private cardiology practices were either being bought by private equity or merging with the hospital. We were in the minority of private practices with a relatively healthy bottom line, causing us to catch the attention of multiple suitors. Their pitch was that financial uncertainty and increasing governmental regulations would make private practice unsustainable in the coming years. My problem was that I had gotten wrinkles and gray hair in the trenches of medicine and knew the bureaucratic mess we would be transitioning into if we decided to sell.
It had been a long journey to reach this point for me, transitioning through multiple health care delivery systems. I was drawn to medical school early in life due to health issues with my dad. I just wanted to be a doctor. While doing my internship in India, I was content to be an employee of the state. In the 1990s, government hospitals in India were still rudimentary. My initial goal was to leave the country, get trained, and return to work in one of the many corporate hospitals that had started popping up.
I ended up working in a smaller hospital that was part of the National Health System in the UK, and clinical exam and diagnosis were emphasized. I was very content with the training, but America was constantly on my radar as the mecca for medicine and training.
America didn’t disappoint. When I finally got my visa and residency, it was everything I had read and heard about. The training was fast-paced and evidence-based, and the cavernous library was a source of wonder and amazement to me. In America, I also had my first exposure to the private practice physician.
Contrary to the caricature in TV series and movies of them being mercenary-like and only interested in money, I found them to be passionate, extremely knowledgeable about their patients, and incredibly skilled and superb at time management. I continued into my cardiology fellowship, and the academic and private attendings were excellent teachers and role models. While the academic attending physicians taught me about research, I began having some exposure to the business side of medicine. It wasn’t something I was personally interested in: I, like most others, just wanted to practice medicine without the bureaucratic headache.
I was getting on in my years, or so I felt — I entered medical school when I was 17 years old, and now, beginning my fellowship training, I was in my early 30s with a wife and two kids. I decided to try academic medicine, but that didn’t work out for a variety of reasons. Like most first jobs, the main reason was me and my unreasonable expectations. I wasn’t looking for a career in private practice; it fell into my lap while attending a conference — an invitation to visit a group in a beach town in sunny Florida. I met a fantastic group and decided to join them; there were no lawyers to read contracts; just a shake of the hand and I was on my way.
It was the best decision of my life. My partners didn’t just teach me about the business side of medicine; they taught me about work/life balance and were the mentors every young physician dreams about. I grew as a person, and my practice thrived. I was enjoying medicine, was able to find balance, and enjoyed seeing my kids growing up. Time flew. I was now the man with the gray hair recruiting new young talent to join us and trying to be the mentor that my older partners had been to me. The headache of the growing practice and the future trajectory was on my shoulders; adding all the changes with MIPS reporting, falling reimbursements, and the ever-expanding overhead made it a heavy burden. Unsurprisingly, I was seriously tempted when the venture capitalists and the hospital came knocking.
Looking back, I realize private practice has given me a full life. I loved what I did; I still got up excited about the day every morning. I could still care for my patients through all the bureaucracy headaches, and we were an intimate part of the community. I was financially stable and was involved in teaching and mentoring the next generation of cardiologists. In short, I was happy and content. When I looked at the number on the offer, I guess the question being asked was, “What is the price of happiness?”
What is your experience with private practice? Would you sell if offered the cash? Share in the comments.
Dr. Arab is Director of Interventional and Structural Cardiology at AdventHealth, Daytona Beach and Clinical Assistant Professor of Medicine at Florida State University. His passions include triathlon, mountain climbing, and writing.
Image by Luciano Lozano / Getty
