New Medical Practice Entrepreneurial Business Rules for Young Physicians [circa 2022]

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Go “Out-of-Box” – OR – Go Employee

By Dr. David Edward Marcinko MBA CMP™

There are more than 950,000 physicians in the United States. Yet, the brutal supply and demand, and demographic calculus of the matter is that there are just too many aging patients chasing too few doctors. Compensation and reimbursement is plummeting as Uncle Sam becomes the payer-of-choice for more than 52% of us. More so, going forward with the PP-ACA OR, perhaps not so much after the Trump election.

Furthermore, many large health care corporations, hospitals, and clinical and medical practices have not been market responsive to this change. Some physicians with top-down business models did not recognize the changing health care ecosystem or participatory medicine climate. Change is not inherent in the DNA of traditionalists. These entities and practitioners represented a rigid or “used-to-be” mentality, not a flexible or “want-to-be” mindset.

Yet today’s physicians and emerging Health 2.0 initiatives must possess a market nimbleness that cannot be recreated in a command-controlled or collectivist environment. Going forward, it is not difficult to imagine the following rules for the new virtual medical culture, and young physicians of the modern era.

A. Rule 1

Forget about large office suites, surgery centers, fancy equipment, larger hospitals, and the bricks and mortar that comprised traditional medical practices. One doctor with a great idea, good bedside manners, or competitive advantage can outfox a slew of insurance companies, Certified Public Accountants, or the Associate Management Accountant, while still serving patients and making money. It is now a unit-of-one economy where “ME Inc.,” is the standard. Physicians must maneuver for advantages that boost their standing and credibility among patients, peers, and payers.

Examples include patient satisfaction surveys, outcomes research analysis, evidence-based-medicine, direct reimbursement compensation, physician economic credentialing, and true patient-centric medicine. Physicians should realize the power of networking, vertical integration, and the establishment of virtual offices that come together to treat a patient and then disband when a successful outcome is achieved. Job security is earned with more successful outcomes; not a magnificent office suite or onsite presence.

B. Rule 2

Challenge conventional wisdom, think outside the traditional box, recapture your dreams and ambitions, disregard conventional gurus, and work harder than you have ever worked before. Remember the old saying, “if everyone is thinking alike, then nobody is thinking.” Do traditionalists or collective health care reform advocates react rationally or irrationally?

For example, some health care competition and career thought-leaders, such as Shirley Svorny, PhD, a professor of economics and chair of the Department of Economics at California State University, Northridge, wonder if a medical degree is a barrier—rather than enabler—of affordable health care. An expert on the regulation of health care professionals, including medical professional licensing, she has participated in health policy summits organized by Cato and the Texas Public Policy Foundation. She argues that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible.

Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today.

C. Rule 3

Differentiate yourself among your health care peers. Do or learn something new and unknown by your competitors. Market your accomplishments and let the world know. Be a non-conformist. Conformity is an operational standard and a straitjacket on creativity. Doctors must create and innovate, not blindly follow entrenched medical societies into oblivion.

For example, the establishment of virtual medical schools and hospitals, where students, nurses, and doctors learn and practice their art on cyber entities that look and feel like real patients, can be generated electronically through the wonders of virtual reality units.

D. Rule 4

Realize that the present situation is not necessarily the future. Attempt to see the future and discern your place in it. Master the art of quick change with fast, but informed decision making. Do what you love, disregard what you do not, and let the fates have their way with you.


I receive a couple of phone calls each month from young doctors on this topic. I ask them to decide if they are of the philosophical ilk to adhere to the above rules; or become another conformist and go along … to get along? In other words, get fly!

Or, become an employed, or government doctor.  Just remember … the entity that gives you a job, can also take it away.

Sample fly:

MORE: Marriage Business


Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.


Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact:




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7 Responses

  1. Practice owner or hospital employee?

    Well said, Dr. Marcinko.

    New, even mature, practicing physicians ask nowdays: Should I remain independent or join forces?

    Dr. Skipper


  2. Top 5 reasons why the physician practice is dying

    Dr. Marcinko – Did you know that physician practices and recruiting experts appeared before Congress recently to testify whether health reform will accelerate the demise of the small practice, in favor of the employment models?

    Young doctors – beware.



  3. Physician employment could hit 75%, eclipsing private practice

    While rumors of the death of private practice have been circulating for some time, a recent survey from recruiting firm Merritt Hawkins suggests it may be no exaggeration that the industry will see 75 percent of the nation’s physicians employed by hospitals in 2014.

    This prediction, according to the firm, is based on the finding that only 1 percent of the 2,710 searches it performed for hospitals and physician practices in 2011 were for solo physicians, down from 22 percent in 2004.



  4. Good job Marcinko

    You are Correct. Things are different now, and the bar for success is higher.

    Instead of arguing over the abstract causes of specialty ot other income inequality, or hoping for miracles from the AMA or Washington, national leaders ought to be sending this message to physicians and all America’s workers.

    Get smarter. Work harder. Go where the opportunity is. Prosperity isn’t going to trickle down from the wealthy, or arrive in the form of a government check.

    The only person looking out for you … is you.



  5. 1 Out of Every 3 Docs Plans to Quit

    Blaming low compensation and the hassles of healthcare reform, 34% of general practice physicians say they plan to leave the practice of medicine over the next decade, according to a new national survey.

    The survey of 2,218 physicians by recruiting firm Jackson Healthcare also found that 16% of the respondents said they will, or are strongly considering, retiring, leaving medicine, or going part-time in 2012.



  6. Why doctors want to quit medicine

    Many physicians plan to leave the medical profession in 10 years, a new survey shows.

    Find out why—and what it means for an aging patient population.



  7. A Video Conversation with Phil Miller on Physician Trends for 2013

    Merritt Hawkins’ Vice President of Communications, Phil Miller, discusses key trends that are likely to have a significant impact on physicians in 2013.

    Merritt Hawkins is a company of AMN Healthcare, the innovator in healthcare workforce solutions and staffing services to healthcare facilities across the nation.

    Hope R. Hetico RN MHA CMP™


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