By Laura Freeman

In a time when many physician practices are being purchased by equity groups, and physicians often find themselves employees of a hospital or a business owned by someone else, is it still possible to be successful in your own private practice?

Brittney Anderson MD, FAAFP, is a real life example of a family doctor who is building an independent career in modern medicine. Since opening her solo practice, Anderson Family Care, in Demopolis three years ago, her appointment book has been full and she has also navigated the business side of private practice.

“I started my career working in a group practice, but I had the nagging feeling that it wasn’t what I was meant to do,” Anderson said. “I wanted to be like the doctors I grew up with in Prattville, and those I shadowed when I was studying rural medicine, and they were all in private practice. I wanted the freedom to be the kind of doctor I wanted to be and to make decisions based on what was best for my patients.

“Of course, a lot of responsibility comes with that independence. In a solo private practice, it isn’t just your career to think about. Your staff depends on your success for their paycheck and the stability of their livelihood. You have to do the work of running a business as well as being a doctor.

“So I started out with a plan to be successful. I built office hours and business hours into my day so that what needs to be done gets done. To last, a practice has to be profitable, so I did the work up front to confirm that there was demand, learned how to work with insurance, and did the marketing—you never stop marketing. Families change, some move away, and others move into the area.

“But you also have to know your limits. Once your list is full, you can’t keep taking on new patients without adding capacity. There are a limited number of hours in every day. You can’t make more by taking the business side of your work home with you. When I go home every night, I leave the office behind. My patients deserve a doctor who is rested, alert and able to focus on them.”

Anderson’s interest in healthcare started early, but it was during a trip to Ghana in college that she realized what she wanted to do with her life.

“While I was in Africa, I got malaria and became very ill,” she said. “They took me to a local clinic for help. While I was there, a father brought in his daughter. They had travelled so far to get care. So my first thought was to become a doctor practicing in Africa. But my father pointed out that right here in the rural South, there are so many people who have to travel long distances to get access to health care, especially in the Black Belt.

“So I decided to practice here, where I could provide better access to underserved populations. When I come to work, I know I’m meeting a real need as a family practice doctor. My patients are terrific. I get to see the whole family and watch the kids as they grow. I also have a wonderful staff. It’s so important to choose the right people, make sure they have the training and resources they need, and treat them right. They should know they are valued, respected and appreciated.”

Managing growth so that capabilities match the need is also an important part of designing a successful practice. “Adding a physician’s assistant has been a game changer. I can make better use of my time. Still, the demand from people in the area who need a family practice doctor are more than I can manage alone. So in November, another physician will be joining me. As you can imagine, a lot goes into choosing the people you want to work with, and setting up an infrastructure where you can work well together,” Anderson said.

Another aspect of teamwork that has to be considered in private practice, especially in a rural area, is having resources you can call on when patients need more specialized care. “Our local hospital is part of the UAB system, and there’s the wonderful MIST system and telemedicine I can call on when I have an unusual case,” she said. “I’ve also built a strong relationship with specialists and hospitals in both Tuscaloosa and Birmingham.

“Now that the local hospital had to close down maternity care, I refer pregnant patients to out of town obstetricians. I can deliver a baby if necessary, but it’s good to have an obstetrician and NICU available, if needed.

“I know when those babies come home, I’ll be looking after them. I like children, but I wouldn’t want to be a pediatrician all day, every day. Being a family practice doctor, I see patients in all age groups, with just about any kind of condition you can imagine. I think variety helps prevent burnout. A specialist tends to get very good on a narrow focus, but the tradeoff is that you see a lot of the same thing.

“In family practice, every day is different. In a rural area where poverty is high and access to care is low, patients can have a variety of extra issues complicating their health.”

This is especially true in an area with a high density of populations that have long been underrepresented in clinical studies. In southwest central Alabama, both ethnicity and economics can influence the frequency and type of conditions a physician may see, as well as which medications are likely to be needed.

To help other physicians interested in private practice, Anderson does a twice weekly podcast called Physicians Hanging a Shingle that covers key topics.

“It takes a certain mindset, and you need the planning and systems in place to get things done and stay profitable,” she said. “You are your patients’ physician and the CEO of your own business.”

In addition to running her practice, Anderson serves as chair of the Alabama Academy of Family Physicians and Vice Speaker of the Medical Association of the State of Alabama.

“Private practice is definitely doable and very rewarding,” she said. “You just have to have a solid plan and follow it.”