In My Own Hands

Private Practice: What it Gave Me, What it Took

Photo by Clay Banks/Unsplash

I am currently a happily retired Ob Gyn physician. Since retiring I have been given many words of advice from family, friends and acquaintances about retirement:

“You won’t know what to do with your time.”

“You will miss the work.”

“Make sure to get a calendar since you won’t know what day it is.”

Maybe since this retirement thing is so new (five months now) I have not yet felt any of the above. I have been catching up on a lifetime without enough sleep (thirty years of delivering babies, and raising several of my own now-adult children resulted in severe long-term sleep deprivation.) I’ve also been spending time with my family, traveling and starting a small consulting business. I absolutely know what day it is. Sometimes, I do miss the work. And sometimes I read a book.

For the last eleven years of my medical career I owned and ran my own private practice. Prior to that I worked in various clinical settings, always as someone else’s employee, and I had never studied business in any formal educational setting. In other words, I had NO business experience when I started. What I had was a strong sense of how medicine should be practiced, lots of family support, a good credit rating, and three ladies from my last job who wanted to work with me. My youngest was starting his sophomore year in high school, and my husband was three years away from retiring as a high school teacher. I took the plunge.

I actually had no idea what I was getting into. Owning my own practice turned out to be one of the most gratifying, rewarding, difficult, frustrating, humbling, satisfying, discouraging and unsettling commitments I have ever made. If all those descriptors sound opposite and incompatible, I assure you that I felt each one of those and more, sometimes all in one day. In the end I am so glad I made that decision so many years ago. I watched the business grow from two hundred to over four thousand patients; my staff and I were the recipients of consistent good wishes (and good reviews) from our patients, and a culture was created in the office that can only be described as “our family taking care of your family.”

The things that made it a success? They were some of the exact same things that made it difficult; starting from number one–The Patients.

I must admit– I loved my patients. I always felt that if my main goal was providing evidence-based, up to date, comprehensive obstetric and gynecologic care in a compassionate and professional way, then my patients would recognize that, appreciate it and respond in kind. Most of them did. Our office received lovely reviews and praise online, patients sent their friends and relatives to us, and just a peek into our small kitchen area would show an overflow of baked goods and patient-provided home made food, even distant from the holidays! I always felt that taking care of women needed to be done in a setting where patients of all ages could feel the respect and concern we had for them, and no matter how big our patient roster became, conveying that concern was always a top priority.

There were always some patients that made my job more difficult: those that let me know that they did not respect my recommendations and did not plan to follow them; patients that asked me to refill prescriptions after not having an appointment for over a year (or two,) refusing to schedule an appointment, and then getting upset when their refills were not sent. There were also patients who asked me for non-recommended non-evidence-based treatments, becoming angry when I would not comply. I never complained to others about these patients; never labeled them “difficult” or “annoying” the way I have heard other doctors sometimes talk about their patients. I always believed we should just treat every patient with heart and empathy. It was my job to educate and inform, and it was the patient’s job to choose among the many alternative treatments in my toolbox.

The next thing that made our office a great place to work was number two: The Staff.

In the last four years of my practice I was blessed to finally find the right combination of front office, back office, medical assistants, nurses, nutritional experts and technicians, where we functioned very much like an extended family. The (all) women staff members were kind, caring, empathetic, dedicated, responsible and fun. We knew each other’s families, spent time together outside the office, and covered for each other. They all had my back and were protective of me and each other. Without my asking, they went out of their way for patients, making endless calls and making sure everyone’s prescriptions and insurance problems were addressed. One of my nurses actually drove a patient to the hospital when she had an emergent problem in my office (and I picked her up later–no comments on liability here please; we did what was right at the time.) When I decided to retire my staff and I all felt that we were leaving a loving and comforting environment.

That being said, one of the most difficult things in running a small private office also had to do with The Staff.

Prior to the last few years I had staff members that didn’t show up, that walked out the back door and smoked pot in the middle of the day, those that left in the middle of a shift, others who stayed late to “finish their work” but were just clocking hours and not working, an office manager that took four hours to do work that I could do myself in two, and a biller who not only walked out in the middle of the work day but destroyed a computer and her whole work station on her way out. Every time I had to look for and train new staff I questioned whether we could continue like this. It just took getting the right combination of great employees to make it click.

The Third thing that made private practice both exhilarating and frustrating: The knowledge that It’s All Me. As much as I anticipated how great it would be to be my own boss and not have to ask anyone else’s opinions about my clinical decisions, being the person responsible for ordering all supplies, all hiring and firing, dealing with plumbing issues and internet problems, and running to the office at 3 AM when the office alarm went off often made me doubt how much I was loving my independence. When there were weeks where not enough money was collected to pay all the office bills (for my first two years in business, during the Covid years, and at random other times) the payroll always went out, and sometimes I took little or no salary home. However when I needed to leave California to help with a family emergency, no one told me that I couldn’t take time off, and no one told me when to come back. I also loved the idea of being a business owner, and feeling that my office was a friendly and comforting space for the patients we took care of. I did love having final say in everything from the colors to paint the walls, to what type of art we displayed and where to have our holiday party.

The largest ever-present misery for me (and there is NO “upside” to this one) was dealing with private insurance companies. If there was one thing that many times made me reconsider continuing to practice medicine in this setting it was this. The insurance system in this country is a disaster. Not one single one of these big companies is doing anything to provide a decent product for their members, and I am convinced that the main role of every one of these companies is to take money and deny care. You would not believe how difficult the insurance companies make it for a physician in a private practice to render good care. Even following all of the many, ridiculous and time consuming rules that the insurance companies create does not result in adequate payment for good or even for great medical care. The hours that my staff spent on the phone trying to get even the most basic medications and procedures approved and the absolute disrespect for my knowledge and patient care are not to be believed. Insurance companies decide that the hour I spent with a complicated patient did not really happen, regardless of my documentation; and even if it did happen, my time spent is not valuable; they decide to “downgrade” the coding for the visit as they see fit. If I decided, with my medical knowledge and expertise, that a patient would benefit from a particular medication, it was often denied, and I was told that the patient needed to try a different (possibly contraindicated, possibly dangerous) medication instead. I never thought it would be right or appropriate to stop taking all insurance; I had so many patients that would not have been able to continue to see me, especially my many elderly patients. So I decided to just eliminate the contracts with the insurance companies that caused me the most problems and paid me the least, while I continued to accept all the others. Honestly, they are all about the same when it comes to interacting with them, and in their total disregard for patients and physicians. As a solo private practice, I had no negotiating power. ALL the companies told me to “take it or leave it” when it came to a fee schedule. And although I formally, via registered mail, informed all of the major insurance companies of my retirement date, to this day I get multiple letters from them stating “Congratulations; we have decided to allow you to continue to participate in Blue Shield’s 2026 health plan!” They are totally unaware I have stopped practicing, and I’m not surprised.

In the end, for eleven years I continued to feel that the positives of working the way I did outweighed the negatives. Until I started to acknowledge that I likely don’t have that many years left where I can travel the world and also be of decent help to my children that are having children. As much as I loved so many things about running the practice for the past decade, I can continue to do the parts of it that do not result in my having to take full responsibility and constantly worry. I can teach, I can lecture, I can write and I can give opinions and non-medical advice, all of which I continue to do.

And I will never pine for the day I had to call animal control when I arrived at work to find a family of deer in my parking lot.