Perspectives on the Private Practice Journey

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Private Practice Pathways in Podiatry: Clinical and Professional Insights

Practice Entry Pathways

• Many podiatrists begin in group or associate positions, later transitioning into independent or small-group private practice.

• Career shifts often occur due to volume needs, private equity acquisitions, or personal/family considerations.

Motivations for Choosing Private Practice

• Greater alignment with family needs and flexible scheduling.

• Limited availability of multi-specialty or hospital-based roles in some regions.

• Desire for autonomy in practice structure, patient care, and long-term career growth.

Appealing Aspects of Private Practice

• Flexibility: Control over clinic hours, scheduling around family and personal life, and ability to adjust work volume.

• Patient Care Opportunities: Greater face-to-face time, potential to build strong patient relationships.

• Subspecialization: Freedom to develop niche areas (e.g., sports medicine, surgery) within podiatry.

• Professional Satisfaction: Ability to align practice culture and services with personal values.

Challenges of Private Practice

• Business Burden: Sole responsibility for billing, insurance negotiations, staff management, and operational costs.

• Financial Risks: Variability in income, especially in early years; risk heightened in crises (e.g., pandemics).

• Administrative Strain: Insurance-related barriers and credentialing delays cited as major pain points.

• Leadership Demands: Necessity of delegation, staff supervision, and continual business decision-making.

Trends and Future Outlook

• Patient Preferences: Increasing dissatisfaction with hospital systems driving patients toward private practice.

• Insurance Shifts: Rising number of practices opting out of insurance contracts due to administrative burden.

• Payment Models: Growth of hybrid and subscription-based practice models; more patients choosing self-pay for quality and time.

• Sustainability: Despite concerns that private practice is "dying," market demand and patient preferences suggest continued viability and potential growth.

Professional Guidance for Early-Career Podiatrists

• Job Mobility is Common: Multiple job changes early in career are typical and not a sign of failure.

• Self-Assessment: Regularly reassess values, family priorities, and career goals; adjust practice type accordingly.

• Mentorship & Networks: Engage with professional societies (e.g., American Association for Women Podiatrists, Practice Management groups) and consider physician coaching.

• Adaptability: Embrace career evolution, recognizing that priorities shift with personal and family life stages.

Transcript

Jennifer Spector, DPM: Welcome back to Podiatry Today podcasts where we bring you the latest in foot and ankle medicine and surgery from leaders in the field. I'm Dr. Jennifer Spector, the assistant editorial director for Podiatry Today. And we are so excited to be publishing this podcast episode in partnership with the American Association for Women Podiatrists. We have two of their esteemed board members with us today to discuss their various experiences and choosing a practice type and eventually landing on private practice. I'll let them handle the introductions in just a few minutes, but we're gonna cover several different questions that many DPMs have about this type of practice journey and they're gonna share their experiences with you. So Dr. Elizabeth Piselli and Dr. Alyssa Carroll, take it away and welcome to the podcast.

Elizabeth Piselli, DPM: Thank you, Dr. Spector, for having us. I'm Liz Piselli. I'm the president of the American Association for Women Podiatrists and I practice in Long Island, New York.

Alyssa Carroll, DPM, AACFAS: Thanks, Jen. This is Dr. Alyssa Carroll. I am the vice president for the American Association of Women Podiatrists. I practice private practice as well in Raleigh, North Carolina.

Jennifer Spector, DPM: So I think it's a great starting point. Why don't each of you share with us a little bit about your journey into private practice, just sort of a quick synopsis of how you got to where you are today?

Elizabeth Piselli, DPM: So I started with working for a group and then I was pregnant with my first child. They wanted me to stay on full-time. I went to go part-time. So I found someone outside of my restrictive covenant radius. Dr. Karen Langone is our immediate past president. And then once my covenant lifted, I was trying to find somewhere a little bit closer to home because that's about 70 miles away. I'm still currently working for her, but then when I couldn't find the job closer to home that I wanted, I created it by creating my own practice.

Alyssa Carroll, DPM, AACFAS: So I also had a little bit of a journey getting to my final, hopefully final destination through private practice. So I started at a private practice in Charlotte, North Carolina, actually right outside of graduating residency. And unfortunately, I just don't think his patient volume was ready for an associate. So I did switch to a larger practice up in Raleigh, North Carolina, had a really great experience there as an associate. And then, unfortunately, that practice did get bought out by a private equity firm. And just the changes as an associate just didn't really align with kind of my long-term career goal. So ultimately, I kind of ended up where I am now, which I kind of think is kind of the Goldilocks, which is, you know, not so big as a private equity, but a little bit bigger than just one or two people. So I'm currently in a private practice that just has a couple different local offices. I've been here for three years and really, really enjoy it.

Jennifer Spector, DPM: Well, that's great to hear. And I know that you both kind of touched on a little bit about what spurred you to land where you are today. But what motivated you to pursue these directions specifically as opposed to other practice pathway options that are out there?

Alyssa Carroll, DPM, AACFAS: So for me, kind of looking at the different options, at least coming right out of residency, your traditional options were kind of a multi-specialty or big ortho group, kind of a smaller private practice or hospital base, I think, or like a VA route. And so I knew just kind of what my family goals were. I kind of understood what my family in terms of my commitment to work, what those requirements would be. And of course, you know, we always say, there's no such thing as work-life balance. You're just kind of a juggling act. So I was trying to minimize the juggling act as much as possible. So for me, the hours and structure of that private practice model just kind of fit our family best.

Elizabeth Piselli, DPM: Yeah that's similar to my journey. Basically on Long Island there aren't a lot of multi-specialty groups that hire podiatrists and I being the Type A person I was I started looking well like very early it's my third year for a job and it turns out the only person that was really hiring was this group at the time and I think I fell into it. One, it was location based. I really liked the location, but two, I think just because they were willing to hire so early, they were organized enough to hire so early. And it was a big group that was looking to expand to be a super group or to sell to private equity or something of that effect. So I think their expansion worked in my favor and it was really a timing thing. I was planning a wedding in residency and I just wanted to have the job for right out of residency that box checked off.

Jennifer Spector, DPM: So in your observation, now that you've both been in this type of practice for a little while now, what are the most appealing aspects of being a private practitioner?

Elizabeth Piselli, DPM: The most appealing, as a mom, I'm a mom to young kids right now. For me, having my own office, being able to schedule the way I want has been really appealing. For instance, I took off the first day of school because my son's going to be in kindergarten. I already blocked off their Halloween parade. And then what's nice is I can then go back to work if I want to because now my office is about three minutes from where I live, which is amazing. So really, the location and the scheduling has been tremendous.

Alyssa Carroll, DPM, AACFAS: Yeah, I would definitely echo the flexibility. Obviously as an associate, I have a little less decision on that, but truthfully, especially at this practice, there's a lot of flexibility given I go in late on Mondays, I get done early on Fridays if I'm not operating. And it definitely allows me to be at more of my kids' events, pick them up from daycare every day, see them off most days, get errands done. It really just affords a lot of availability to more than just going into the office. I would also say another aspect of it, for me at least, is as opposed to some of my friends and colleagues in some of these bigger institutions, I think there's a lot of potential for what my practice could look like. And so, we're starting to do a little bit more sports medicine and I'm loving that direction. But if, you know, ultimately, I want to focus more on surgery, there's the potential to do that. So I love that there's endless opportunities to kind of subspecialize, if you will. And there's a lot of support to do that in my practice.

Jennifer Spector, DPM: It's interesting to hear the different perspectives on that too, based on being a solo practitioner versus a group practitioner. and also, I'm sure there's some regional variation too, but in your observation, what do you feel so far are the most challenging aspects of being in a private practice model?

Alyssa Carroll, DPM, AACFAS: I think my answer is probably a little more obvious in that I'm in that associate role. So, you know, I still have a boss and I still have someone, you know, to answer to and some of the decisions are made, you know, for the betterment of the business, right? At the end of the day, this thing has to keep going. So sometimes it's challenging, you know, if kind of the goals are misaligned in terms of making decisions when it comes to the business aspect. I would also say, one of the things I constantly think about, because we all just went through it, was if another pandemic happened, I don't have the security of a big institution behind me like I did when I was with my bigger practice. I'll never forget the private equity firm that was in charge basically, they were paying associates without getting any production coming in. You know, it was eventually balanced out and everything. They weren't just giving out money, but I mean, they really supported the associates during that time. So there's definitely some risk with being in a smaller practice that could be fragile, especially in a situation such as that.

Elizabeth Piselli, DPM: There are excellent points and something I hadn't thought of for me in my own practice, the buck starts with, stops with me so that can be challenging, keeping the practice aligned with my values meaning I want it to be a certain type of practice. I want there to be certain certain priorities, especially for me, it's customer service. That's a really important priority for me and trying to always stay on top of my staff to do that. Though I'm the one that's fighting with insurance and I have to get better at delegating so learning to be a leader is part of that. But there is some, especially I'm about three years in now and just the learning curve's been tough. So there's some, to Dr. Carroll's point, there's some times where my medical assistants are taking home more than I am just because I have to keep the lights on and so there's that challenge of we have to keep I have to keep the business running it's on my shoulders if I don't see patients I'm not making money if I'm not making sure I'm billing correctly I'm not making money the the fallback is always me if my biller isn't performing well that's I have to check that so it's always me, which is a challenge sometimes a fun challenge, but sometimes just too challenging, getting on the phone with insurance companies that I'm supposed to be credentialed with, et cetera. I think that insurance companies are the most challenging part of private practice in general, but owning your own practice, I think just that everything is you.

Jennifer Spector, DPM: I think that's one reason that when I was in practice, I never really aspired to own my own practice because I knew that and I realized that and I knew that that was not a path that was going to be compatible for me long-term. So I have so much respect for the folks that undertake it because I know how much it must take. But as we've all mentioned, there's pros and cons to every opportunity within practice. But now that you've been in this for a little bit, do you see any trends or changes on the horizon for private practice in the next series of years, maybe a year from now, but maybe even 10 years from now?

Elizabeth Piselli, DPM: What I'm seeing really is that patients are fed up with the hospital system. And it's funny, even my aunt, who's a little bit older, loved that if she goes to this one local hospital system, all of her history is in there. She never has to fill out a form ever again. And I can see why that would be really appealing because forms are annoying. But then she was just venting to me the other day, she actually in my front desk, she was just saying, "I never want to go to another doctor. Nobody listens to me." She just sees the back of their head. And I said, "Well, that's what happens when you go to these big systems. Yes, you don't have to fill out a form again, but nobody's listening to you." And she was even saying, "Yeah, you're in the room way more than any of my doctors have been combined." And I said, "Well, that's the freedom. That's what I want to be." And also, I think that's what people want. And people are, I think the trend is going to be towards more private practice. I know some people whispering private practice is dead. I don't think that's true because I think the market's gonna drive people that way, whether they're paying for it out of pocket to get better service or whether they're just gonna start moving in droves to that as long as we stick with it and keep private practice alive. I think that's where people want. And then what I foresee happening is the hybrid model where private practice becomes part paying out of pocket for those extra services, maybe even part subscription model. That's what I see going forward.

Alyssa Carroll, DPM, AACFAS: And it's so funny because, you know, Dr. Piselli working up in New York, and I'm down here in North Carolina, you could certainly say our demographics are, you know, probably very different. But truly, I would have to wholeheartedly agree. I mean, we have already really started to do—so first of all, slowly, I think the trend has been more private practices are opting out, especially these insurances that are just keep, you know, such an admin burden on your staff, as Dr. Piselli mentioned earlier for her herself, because she's having to deal with those companies. And I think practices are getting fed up, but exactly—patients are as well. And I think I've seen a trend of more and more patients that will defer using their insurance, opt to do self pay, or will go for a self pay service that's not covered by any insurance because they know the quality of the care is there. They appreciate the time, they appreciate that the results speak for themselves for a lot of these therapies that are being offered and less insurances or covering them, even basic things like orthotics within the podiatry world, less and less insurances will cover them. So I would absolutely agree with kind of that trend that I think there could be a boom in the private practice sector in addition to seeing more private practices opting out, maybe not necessarily going to like a concierge model, but definitely having less strings attached, if you will, to these insurance companies.

Jennifer Spector, DPM: Well, this so far has been a really great synopsis, I hope, for our audience on what your experiences have been and what your pulse check is today, sort of on the world of private practice. But is there anything else that you want the audience to know that you've learned along the way in your journeys?

Alyssa Carroll, DPM, AACFAS: I think the first thing that comes to mind for me and talking to so many different women, especially as you're kind of figuring out what is right for your family and what's right for you coming out of residency or your training fellowship is it is very common to have to have to go through a couple practices to find your right fit. And I don't think there—I had a lot of shame in that when, you know, when you tell someone, okay, I've had three different jobs. I think traditionally, there's kind of a negative connotation towards that. It's like, well, why, why do you have to keep, you know, making these changes, especially so early in your career? But I think it's extremely common. I think it's rare to find someone who is still at the same place that they started. And so I would just encourage people, don't settle, find what works for you. It's oftentimes very hard to find that right off the bat because, hey, you don't necessarily know exactly what you might think you do, but, and also it just might not be available at that time. So keep your options open, really check in with yourself about if you're happy and if the job is aligning with your goals, your family goals and just know that, it's probably a necessary part of the journey.

Elizabeth Piselli, DPM: Those are excellent points. I would definitely say the reassess is really important throughout even in the like the tech world my brothers are in the tech world and they've had to bounce jobs and often for them so it happens across the board and I know like our parents' generation is like, no you stuck with a company, but companies aren't loyal to you and similar you have to do what's right for you like in order to advance you have to jump companies like in tech that's how it works really really. But for us, yeah, sometimes, all of a sudden, I thought I would be the type of mom that would want to work full time, then, lo and behold, my daughter's born. And I was like, whoa, there's no way, there's no way I want to give up my career, but it's that I work so hard for, but there's no way I don't want to have a significant role in her life. And for us, what worked was the part time practice for me. So yes, just looking at your life, seeing, you know, taking a breath and reassessing. I would also say get involved in those different societies like the Practice Management Society, American Association for Women Podiatrists. There's so many people out there that have gone through what you've gone through and are willing to help. And it's okay to talk to someone, whether it's a coach. I think Dr. Spector, I think you had recommended a coach to me at one point when I'd asked you. There's different pathways and you don't have to feel stuck at your first job. Yeah, reassess your values and they're going to change throughout your life. So it's important to look at your career and see how that's fitting with the life you want and not the other way around. Don't try to fit your life to the career unless that's the most important thing to you. So just look at yourself, look at your values and continue to reassess throughout your life.

Jennifer Spector, DPM: So you make us such a good point. We have discussed on podiatry today before as well about the concept of physician coaching and that is definitely something that's open to people in every type of practice. But thank you so much to both of you for sharing your private practice journeys with us today. We are so grateful to the audience for joining us as well. You can find this and other episodes of podiatry today podcast on podiatrytoday.com under education and podcasts, but also on your favorite podcast platforms like Apple Podcasts and Spotify. We hope you'll join us for this in future episodes and we also would like to thank our partner, our organizational partner, the American Association for Women Podiatrists. Thank you and have a great rest of your day.

Published in partnership with the American Association for Women Podiatrists.