For many, this would be a dream scenario… no insurance companies to deal with, lucrative self-funding patients only, no NHS criteria or waiting times to worry about and complete autonomy. Aesthetic medicine and refractive surgery largely fit the bill here, as insurance companies do not cover these specialties, and of course patients are usually willing to part with their money for such services. For other specialties, choosing to see only self-funders can present problems, as your referrers will not always be aware if their patients are insured or not. Why send them to a selective consultant, when they know that another consultant will see all referrals?
Towards the end of one’s career, refusing to see insured patients may be the icing on the career cake. It is unlikely that referral practices will change much in your twilight years and avoiding the hassle of some insurance companies may provide a real panacea for private medicine ennui.
The author does not see members of some insurance companies as insured patients, largely due to the fees on offer being insufficient to make business sense. As a result, some such patients self-fund the entire package (including the hospital fee) in order to see the clinician of their choosing, highlighting their choice of insurer as somewhat undesirable. Although the financial effect on patients is undesirable, this particular scenario can be extremely satisfying for clinicians who have borne the brunt of insurers' myopic policies.
Seeing only insured patients
This would be a highly unusual desired practice, however, it is not unusual for clinicians to start their practices in such a way in 2020. Thanks to the advent of managed care pathways, insured patients are often directed towards fee-assured consultants, who may preferentially receive referrals before more established, but more costly consultants. This may help you to kick-start your career, getting your name known in the local area and hence hopefully a few self-funding patients.
Seeing all private patients
This is how most clinicians practise, seeing all patients referred, be they insured or self-funding. For clinicians new to private practice, recent tactics of insurance companies limiting your fees to certain levels will potentially cause you headaches in determining your fees. Unless you set your fee levels at the level of the lowest insurance company reimbursement level, you will de facto need to have a differential fee structure for differing insurers and for your self-funding patients. This can be complicated to manage, but moreover could potentially lead patients to ask why you are charging one patient more than another for the same service? Another way of dealing with this situation is to state that, for the avoidance of doubt, your fees are the higher figures, but that you offer discounts to various insurance companies for business reasons.
Seeing all-comers allows your referrers to know that you will not turn away patients that are referred to you on the grounds of cost, which is good for your overall business. As you become busier, you may wish to make sensible business decisions to avoid lesser paying work in favour of self-funding, or properly insured, patients. Patients with less expensive insurance, which tends to be associated with managed care pathways, are often aware of the reduced choice that such products afford them.
Seeing both private & NHS patients in a private hospital
To increase one’s business, this is extremely common behaviour amongst consultants and has a number of advantages. Firstly, it can lead to enhanced income, plus can allow you to command a private hospital theatre list earlier in your career than if you had gone down the purely private route. Secondly, it will market your services to your referrers, which is rarely a bad thing. As you grow busier with private patients, you can always reduce the amount of NHS work that you do, maintaining your throughput, but increasing your income (but simultaneously your indemnity costs).
However, consideration needs to be given to the effect that offering your services to both private and NHS patients has on your brand. Does it reduce the exclusivity and desirability of your brand? Why would patients wish to pay to see you, if they can wait to see you via a ‘Choose & Book’ arrangement? Perhaps an alternative would be to see NHS patients only via waiting list initiative arrangements; patients therefore could not choose to see you, but you could still tap into the NHS market to boost your business. Alternatively, you could provide private services in one venue and NHS services in another, but this might limit the geographical appeal of your private practice.
Ultimately, it is up to you to decide how you divide your time. For some, simply providing clinical services alone is sufficient reward and you may not worry regarding the associated income.
Medicolegal work
Some practitioners only carry out medicolegal work, whereas others will offer it as part of their private practice. Like anything in medicine, it is best not to dabble and there are many pitfalls that await those who do not understand the medicolegal world well. If you choose to do it, ensure firstly that you understand your brief and its specialist subject, and secondly that you are properly indemnified for the work in question (NB. Indemnity insurance for private clinical work is not likely to be sufficient).