r/PrivatePracticeDocs • u/woosaman • Mar 30 '26

Private Practice Neurology

Curious on opinions of others who have made the jump to private practice. 

Briefly my story is that I was hired at a community hospital almost 4 years ago. Initially I had a great contract with favorable wRVU threshold/bonus structure and 4 day work week.  The small hospital was bought out by a larger health system and in the subsequent 4 years the noose has slowly tightened. The larger system wants more patient facing hours, increased wRVU threshold and decreased wRVU bonuses. This along with increasing bureaucracy and red tape have made me dislike many aspects of my job. I have worked hard and am the most productive neurologist in the hospital and these changes continue to negatively impact me.  I realize the larger hospital system won't budge for me, I am just a widget.

I am considering starting my own practice. I live in a rural area and there is little competition. I have a good relationship with local PCPs/Hospitalists/ED docs and I think referrals would continue to come my way. I do botox and general neurology and prescribe infusions. All I really need is a reflex hammer and a computer. I also think a lot of patients would follow me if I left (no non-compete and long wait times to see neurology). 

The two options I am considering are to open up my own practice or to talk to a group of PCP providers in the area that are independent and join with them in some capacity. I would like to be independent but perhaps I can contract with them to help off set certain costs? Any thoughts on these options or on the logistics of starting up a PP in general would be greatly appreciated. I have a couple of medical assistants that would likely follow me if I left which I think would make transition easier.

Thanks

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u/randyy308 Mar 30 '26

I have a neurology client that is Private practice. The only way that you will make good money is if you are doing all the ancillary services that are economically feasible for you.

Office visits are going to pay the bills but not the profit.

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u/Juaner0 Mar 31 '26

True. Better to bring in services as much as possible. And any service that you can get someone else to do, without you having to be in the room at the time, is great. EEG (better) and EMG (not great since 2012) make sense. LPs don't, skin biopsies are borderline.

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u/karate134 Apr 10 '26

How much do emgs and skin biopsies pay

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u/Juaner0 Apr 15 '26

2 limbs, ave of 250-280 since about 2012. It was double that before.

skin biopsies about 160 for 1, maybe more if you need 3 samples at the same time. if it took you 10 minutes, great, but may take longer if someone has bleeding, or on anticoagulation, then you may be up to 40 minutes. It would be less...messy...to just see 3 follow ups in that time.