In the current era of medicine, it is relatively rare to find a solo rheumatology practitioner. Whether due to administrative or financial burdens, insurance and reimbursement challenges, changing priorities with regard to work-life balance or the overall trend toward consolidation in medicine, it simply is not as common as it once was for a clinician to operate their own practice. In a study published in 2021 by Izadi and colleagues, only about 8% of the nearly 60,000 patients whose data were available through the RISE registry were seen by a solo practitioner.1
However, some rheumatologists have achieved success and fulfillment in solo practice. One such physician is Anna Zezon, MD. Dr. Zezon received her medical degree from the Sackler School of Medicine at Tel Aviv University (the program is a partnership between the U.S. and Israel). She completed her internal medicine residency at Montefiore Medical Center/Albert Einstein College of Medicine, The Bronx, N.Y. She went on to complete two fellowships at NYU Langone Medical Center, one in rheumatology and one in geriatric medicine. Her research activities during her training focused on a geriatric cohort with systemic lupus erythematosus (SLE). Dr. Zezon has published articles on topics that include the rheumatic manifestations of autoimmune thyroid disease and the safety of discontinuation of hydroxychloroquine in older patients with SLE.
TR: Can you talk about how you developed the idea to start a solo rheumatology practice?
Dr. Anna Zezon
Dr. Zezon: I was working at a hospital-owned practice and was intrigued by the business side of medicine. Certain circumstances required me to get involved in understanding how claims and billing were done and how the infusion business runs. Leaving an established practice has risks. At that point in time, I felt like I was able to take risks in favor of a trajectory of growth and more independence.
TR: What were some of the practical first steps you needed to take when starting your practice?
Dr. Zezon: The task that takes the longest is credentialing with insurance companies. There are a few things you have to take care of quickly to get the ball rolling on credentialing. I needed to incorporate the business, obtain a tax identification number and find a location. You need a practice address to start credentialing with insurance companies. The most important thing I did was form a network with like-minded individuals who took a similar path. I joined a group on Facebook called Rheumatology Private Practice Alliance (RPPA). Through this group, I was able to ask questions and get answers quickly to challenges we all face when starting a private practice. I also met some local individuals at their early stages of practice formation, which was very beneficial to me as well.
TR: How did you advertise your practice and begin to build a panel of patients?
Dr. Zezon: I was working in this same geographic area prior to going solo, so I had a following and a referral base. The referral base was the most important factor in establishing a patient panel. I also worked locums in parallel to starting a solo practice, and this helped reduce financial stress as I built the practice.
TR: What are some of the biggest challenges in running a small business?
Dr. Zezon: The administrative tasks are definitely challenging! Finding good employees is difficult. I learned it is worth having some staff redundancy even when you are very small in order to avoid situations in which your employee does not show up. I also had a challenge finding office space. There were very few options for an office location. I did not want to sublet, and most locations looked really run-down. I decided to get a space on my own—one that is bigger than what I really needed—and sublet to others. By taking this path, I created a nice community of independent practices that share the same space, with all of us helping each other out and developing great synergy.
TR: Did you receive any business training in or outside of medical school/residency/fellowship? If not, what do you wish was taught during medical training to help prepare doctors to open their own practice?
Dr. Zezon: No, I did not receive any business training prior to going solo. I think it would have been helpful for private practice rheumatologists to come and give us a few lectures about the business side of medicine, and perhaps for us as trainees to spend time in the private practice setting.
TR: What have been some of the most rewarding aspects of running your own practice?
Dr. Zezon: First and foremost, the relationship with patients is priceless, and I can deliver the care my patients really need with [fewer] barriers. On the business side, there have been many joys: seeing my own practice grow, running and expanding an infusion business, hiring star employees and seeing them flourish, achieving independence and definitely experiencing the autonomy that running my own practice brings. Each of these have been amazing to me.
TR: What advice would you give graduating fellows interested in starting their own practice? Is this the same advice you would give to a rheumatologist already in clinical practice who is looking to become a solo practitioner?
Dr. Zezon: Yes, I would give this same advice to someone who is currently in practice and is looking to venture out on their own. The best way to go about it is actually getting help from each other so we can learn from each other’s mistakes and learn from each other’s successes as well. I would not have been able to do this without the help of the rheumatology private practice community, specifically the RPPA group run by Karleen Su, MD.
Jason Liebowitz, MD, FACR, is an assistant professor of medicine in the Division of Rheumatology at Columbia University Vagelos College of Physicians and Surgeons, New York.
Reference
- Izadi Z, Schmajuk G, Gianfrancesco M, et al. Significant gains in rheumatoid arthritis quality measures among RISE registry practices. Arthritis Care Res (Hoboken). 2022 Feb;74(2):219–228.
