How a Smaller Practice May Offer More Autonomy in Your Work

To better understand the dynamics of a small practice, we spoke with Dr. Ahmad Mian, Mohawk Valley Nephrology Associates in New Hartford, New York and Dr. Poonaiah Mohan, Renal Associates of North Texas in Arlington, Texas. Here’s what they had to say.

Dr. Mian began by explaining his thought process on establishing his practice in central New York, “I wanted to grow my practice and mold it into what I wanted it to be. I had a vision for a practice that was more patient-centric. I believe that if you make everything about the patient, everything else follows. I was very lucky that my senior partner practiced the same way. I think a lot of my outlook came from him and we have good chemistry in regards to our philosophy of patient care.”

The US Renal Care Physician Services team is often talking with nephrologists who share Dr. Mian’s priorities. Many physicians have a strong desire to not just work in a practice, but to shape its philosophy of care. Practices such as Dr. Mian’s in the Hudson Valley offer a great opportunity in a mid-size market to do just that. They are large enough to see good patient volume, but small enough that the nephrologists who work there have the autonomy to make the decisions that influence the practice.

Dr. Mian illustrated the point well as he continued, “For any major decisions, such as practice management decisions, we involve the doctors. For example, we recently decided to change the call schedule structure. That would affect a new practitioner coming in so in that case we would talk to them first before we made any changes.”

There can be a surprising amount of variance in how nephrologists work. Some practices have more rigid structures while others allow for more flexibility. Dr. Mohan noted the biggest difference being in a small practice is that, “I can choose how I want to work. I wanted a certain level of independence, which is a big factor in why I chose a small practice.”

Finding that level of independence isn’t the only way small-practice nephrologists can shape their working environment. Dr. Mohan went on to point out another major benefit of going small, “In a large practice, you don’t necessarily get to choose who you work alongside. Whereas in a smaller one, you get much more say [when it comes to] who gets hired.”  When it comes to enjoying your work, having a good group of peers around you is just as important as having a good schedule —  and also critical for the health of the practice.

One of the lesser known benefits of joining a small practice is the opportunity to try new things. Dr. Mohan explained, “If you have an idea or want to change how something is done, there isn’t a lot of red tape or bureaucracy to get through. Typically, you only need to sit down with two or three people and have a conversation. That level of accessibility is unique to small practices.”

Along with compensation, work/life balance is one of the most important things to today’s workforce. Perhaps more than ever before, people are prioritizing the ability to spend their personal time the way they want and creating space for the things that matter most to them. 

Dr. Mian confirmed that was the case with an anecdote from their own practice, “I’ve found that small group practices are more tight-knit. We look out for each other. I tell this to my Nurse Practitioners as well. One of my NPs has a child with special needs and sometimes he needs to take unscheduled time off. We accommodate that because I believe family comes first. If I need time off or if I need to be somewhere my partner will chip in and vice versa. A small practice can truly become like a family.” 

Dr. Mian expanded, “When you are in a larger practice you have to abide by the rules of that practice. To get PTO you have to put in a request and it has to be approved…senior practitioners often get first dibs on selecting PTO days,” adding “with smaller practices, I’ve found you typically have more flexibility. I encourage my NPs to go and attend their kids’ events, go see their families, go to their doctor’s appointments, and then come back to the office or do the work later. I want to encourage our people to have lives.” He concluded, “At the end of the day, if the employees are happier and more satisfied with their work and how they are treated, you’re going to get better work out of them. There are many benefits to the nature of the close-knit relationships that are formed in a smaller practice.”

Dr. Mohan agreed, “I feel that the main advantage of small groups is that you can choose your schedule. I am my own boss right now. It’s just me and my partner mostly, though we do have a couple of part-timers that cover for vacations and that sort of thing. It requires a little more planning, but it works out well.” Dr. Mohan feels the work/life balance in a small group is very good, adding, “If someone joins us,  they are only going to be working one weekend a month. There is a misconception that in a small group, you’re going to be working a lot more since there are fewer people but that simply isn’t always the case.”

Like most things, there are pros and cons to working in a small practice versus a large one. As you consider your options, make sure you understand when you will have a voice in the workings of the practice, the opportunity for career advancement, and the flexibility to manage your schedule. For those with an independent and entrepreneurial spirit, a small practice might just be the perfect fit.

Curious about what opportunities are available at practices across the country? Check out our job board and get in touch with our team so we can connect you with the openings that best fit what you are looking for.