Can a Physician still start their own Private Practice?
Interview with Dr. David Tenembaum
By Tatum Rauch
This is Sapient Health’s first of a series of interviews with young physicians who have created thriving independent practices, eschewing overtures from hospitals and PE-backed platforms to strike out on their own. Our first interviewee is Dr. David Tenembaum, a Queens-Based gastroenterologist who partnered with an experienced doctor and his practice in 2016.
SAPIENT: What were you told during residency and fellowship to prepare you for your first independent position?
Dr. Tenembaum: Not much, honestly. I'd say that the hospital subconsciously prepares you for a hospital-type job; you're working with people who work for hospitals, and they only know what working for hospitals is like – they don't really know that there is another option out there. I would also say, there was a tremendous amount of preparation around being ready to take care of patients, but there was very little preparation regarding what type of job to pursue and what would need to be done outside of patient care. When I left, I felt ready to take care of patients, but in terms of the non-patient parts of being doctor, I wasn’t.
SAPIENT: When you were being recruited out of residency, who were you speaking to? Practices, hospitals, corporations?
Dr. Tenembaum: All the above. I met with New York private practices and hospitals for full-time positions. I went to private practices in Connecticut. I went to hospitals for GI hospitalist work. I went on other interviews just to see what else was out there and not close any doors. I knew I wanted to start my own private practice, but I also knew you're really starting from zero, and it may take a year for me to get into an insurance contract, which is tough, but that's the reality of going into private practice. Because of this, I was strongly considering a hybrid position, part-time at one of the local hospitals where they were allowing me to open a private practice and work there two to three days a week.
SAPIENT: So how were you able to go straight into private practice?
Dr. Tenembaum: I joined a private practice with a gastroenterologist who was nearing the end of his career. It was a perfect match because he was looking to slow down, and I was looking to start up. We both liked a new second location where we could open an office-based endoscopy suite and another office to see patients. It's been great ever since. The biggest advantage was that I could be added to insurance plans under his tax ID, which made things easier. I also got lucky because my partner is a good, honest guy. As a fellow coming out of training, hospitals often try to scoop you up cheaply, and you need to start growing your practice from the hospital. He was very honest and fair. We have worked as partners from day one.
SAPIENT: How was the initial compensation?
Dr. Tenembaum: Initially, it was okay. I understood what it meant to go into private practice: the more you work, the more you get compensated. But when you have a private practice, your overhead can be anywhere from 40% to 60%, so it was a bit of a ramp-up. I didn't care about an upfront salary. I didn't need guaranteed income. I cared more about building a practice that was my own. Now, private practice isn't for everybody. I know many doctors that don't belong in private practice—they should be part of a hospital system. I've had friends in the past who were part of the hospital system, and I felt their talents were wasted as their potential in a private practice setting was tremendously high. Once they eventually left, their new practice exploded. It goes both ways. Not everyone's meant for private practice, and not everyone's meant for a hospital. I've always felt that I was much more comfortable in the private practice setting, making what I earn and being my own boss.
SAPIENT: What was the most daunting part of striking out on your own?
Dr. Tenembaum: A few things: I think convincing someone that I was going to work hard was one. Not having a guaranteed income while starting a family was another. But really, failure to succeed, right? That was the biggest fear – what if six months down the line I only have ten new patients? But I was confident that I'd be able to do well. I knew that if you worked hard and treated people well, it was just a matter of time before things got busy. Yes, in the first year of private practice, you’re probably going to make a lot less money than if you joined one of the big hospital systems. Understanding and being okay with that helped reduce the pressure.
SAPIENT: How long did it take to develop a busy practice?
Dr. Tenembaum: Not that long, partly because I knew I was going to start this practice years before I graduated – I was preparing for it for a long time. While I was in the hospital, I treated the outpatients like they were part of my private practice. Patients had my contact information, including my email and cell phone. I was already being referred patients before I graduated from my fellowship. Even in the first week out of fellowship, I had a hundred patients lined up to be seen in my office because they all said, "Wherever you go, I want to go." I already had patients sending family members to me because they liked me, and I had treated them well in the hospital. To this day, I have patients who come to me that I met in the hospital, patients I treated for severe illnesses and cancer. They are still my patients today. So, I wasn't starting from zero coming out of fellowship. Clearly, the hospital benefited while I was there, but they were training me. I knew where I wanted my practice to be, so I stayed in Queens for that exact reason. I was also fortunate that my dad was a surgeon in the community, which was another huge advantage. Many primary care physicians in the community had attended my bar mitzvah. I took them out to dinner, and spent a lot of time with them. I was doing my best to set myself up for success by making sure they knew where I was. They all had their existing GI relationships, but they were all nice enough to send patients to me from day one.
SAPIENT: Do you have any advice you would give to new residents?
Dr. Tenembaum: Yes. In the hospital system, there's a feeling that you can't go into private practice, and that's just not true. I would remind everybody that as physicians, there is a huge market and need for private practice doctors. I remember people saying that you can’t ‘make it’ as a private practice doctor: “Nobody’s doing that anymore. It’s out of date. You can’t make any money.” I don’t agree with any of that, I believe there market out there for private practice doctors. My one piece of advice about private practice is that it's fun. I love it. There are advantages and disadvantages, but there is a market out there for private practice doctors.