When should I go full-time in Private Practice?

When I’ve been coaching Clinicians in Private Practice, I’ve found that when people make the leap from working part-time to full-time, it’s often because they are motivated by wanting to leave a working environment that is frustrating them or even suppressing their growth.

Having dabbled a bit in their own gig, they begin to see the light and realise that if they worked at it, they could entirely be masters of their own destiny.

Sometimes this might occur when the NHS has repeatedly given them a kick in the teeth (and let’s face it, the recent pensions and tax fiasco has left many people reeling).

Sometimes, it’s feeling frustrated about giving half your earnings away to the manager of a physio practice, with little in return in terms of career development.

In my case, I stood up to a bully and in doing so, knew I was getting myself kicked out of a job. Now I’m not advocating that you do anything as drastic as that, but it did at least teach me how to very rapidly grow, from scratch, my own practice, because I had zero income. It was scary, but I’m very glad I did it, because I could have procrastinated for years, before I might eventually have gotten around to making the jump.

It’s important to be aware that the grass isn’t necessarily greener in the full-time Private Practice.

Nevertheless, if you are feeling restless it may be a sign that you are ready.

Here’s what I recommend you mull over:

Ask yourself honestly what it’s going to cost you.

It’s very important that moving into full-time Private Practice doesn’t make you poorer and part of the aim should be that you have a better income (and more importantly) a week that is structured more to your liking.

If you have an income (either employed or contractual) from the NHS or if you are working at someone else’s physio or osteo clinic, there will be certain things you will have to start paying for yourself if you set up entirely on your own.

I recently recorded a about how much it costs to work in Private Practice:

In a nutshell, your overheads will include the following – some of these may be currently be paid for out of your own pocket, but most won’t be:

  • Consulting room costs
  • Medical administration, VA or secretarial cover
  • Medical billing
  • IT and Tech Accountancy and bookkeeping
  • Indemnity
  • Marketing
  • Education and Conferences

Ask yourself what else you will be giving up by going full-time.

If you’re employed, you might be giving up holiday pay, maternity or paternity pay, sick pay, time off for educational events, and an all-important pension (contributed to by your employer).You’re going to need to do your maths and work out how much it’s going to cost you to set up your own pension, income protection, and arguably, private health insurance for yourself.

If you’re currently working in a contractual role, it’s less likely that you’ll receive these benefits, but now’s a great time to get that stuff covered, if you’ve not already.

Beyond the benefits issue, you also need to consider the following if you’re going ‘full-time solo’ :

1) Ideal working space.

You may find it hard(er) to secure the kind of working space that you want to work from. For instance, you may be a Physio or Osteo, and want access to a sort-after gym space, adjacent to clinical room you would be working out of. You might be able to get around this problem by joining forces with another clinician to share the cost of a jointly-hired place, but remember that this might raise issues about room availability and deposits

2) Losing referral sources.

It’s a no-brainer that stepping out of NHS work means you lose income from seeing NHS patients, but if you’re currently working in Private Practice at someone else’s clinic, there may be informal referral arrangements that you lose by stepping out of it. Interestingly, this is one area that holds Clinicians back more than it needs to. In my experience, even if there’s a ‘restrictive covenant’ in place, if you’re leaving a practice, it’s entirely possibly to gain new referral sources quickly and easily. If this is tying you in knots, don’t let it.

3) Losing out on contracts with private health insurers.

This is an interesting one. Many Doctors, Physios and Osteos serve patients who have private health insurance. Some health insurers are currently not taking on solo clinicians, and even if you’ve seen privately insured patients at the clinic you’re currently jobbing at, often the insurance set up is with the clinic, and not with you as the individual clinician. The flip side of this is that you may decide to drop seeing patients whose private health insurance pays you peanuts. You can then set your own self-funding patient prices, and attract your kind of patients, which is really liberating.

4) Loneliness.

Yep. It’s a thing in Private Practice.

Many Consultants who are still working in the NHS cling to the comradery of working with colleagues, and may be concerned about feeling lonely, working toutes-seul in a private hospital clinic room.This is entirely rectifiable, and part of forming good referral networks means being proactive in terms of meeting people, as well as working in MDTs. Quit moping and get out there!

Ask yourself “am I the right kind of person to go full-time?”

Spoiler alert: Full-time Private Practice isn’t for everyone.

  • You need to be able to handle uncertainty, after all there’s no absolute guarantee that patients are going to come to see you in clinic. Interestingly, once you are responsible for your own marketing that drives patients to book in with you, you are actually in far more control than you realise.
  • You might think you’re not naturally a ‘self-promoting type’ which means you have to get your head around the idea of marketing yourself. The full-time Private Practice clinicians who make a great living, actively do this, and yes, it’s entirely possible to do this in an ethical way, even if you’re a massive introvert. If you really can’t stand the idea of talking about how you can help people, full-time is probably not for you (unless you intend on eating packet noodles for an eternity).
  • You are always responsible for your patients, whereas in the NHS, or someone’s clinic, you have cover from colleagues. Don’t worry too much about this, as you get to choose which patients you see, and plan when you see them. You can always buddy up with other clinicians if you have to take emergency leave.
  • Some people don’t like the idea of ‘competition’ and aren’t interested in learning about business in general. Is that you? Or, could you be persuaded to learn those business and techy skills (which I think is actually the fun part)?
  • You may also have some nagging feelings about leaving the NHS, or clinicians who’ve ‘really looked after you’. Some people may even try to guilt trip you about leaving the institution that trained you. I would argue that there is no better way to take care of your patients than in Private Practice.

Then have a look at the advantages.

Private Practice means you get to choose the patients that you want to see and get to treat the conditions you want to treat.

You might find that moving full time into Private Practice is a relief as you can have ready access to the investigations and treatment options that are so tricky to access swiftly in the NHS. Often consultants delight in the end of the NHS bureaucracy and also the end of the responsibility for juniors, training and a big pressure to carry out research.

If you’re a Physio or Osteo, setting up completely on your own means you don’t have to abide by ‘the way it’s always been done’ in someone else’s clinic. If you want to treat patients for an hour and never less than an hour, go right ahead!

And the money. Let me just come out and say it. Yep. You can make a very nice living in full-time Private Practice – far beyond that you would earn grinding it out in the NHS or slogging away for someone else. Your money, earned on your terms.

We often have reasons that hold us back – which are yours?

  • Are you doubtful that you have what it takes to work full-time in Private Practice? What anxieties might your well-meaning spouse or family be propagating?
  • Are you worried that you’re going to be hugely financially vulnerable by quitting a predictable income? There’s a bit of a myth that it takes five years for people to get fully up to speed in full-time Private Practice. In my experience if you’re prepared to do the work, this can be expedited to as quickly as six months. Build yourself a small financial buffer if you can do, shrug off the invite to that ski trip, and hold off from buying that iMac Pro. Needing to earn the money is an underestimated motivator for success.

If you’re looking for help to make the leap from part-time to full-time Private Practice, get in touch at css@privatepracticeninja.co.uk


email or call us 0207 993 6425