Monday, January 01, 2007

Ring in 2007 with renewed vigor for Medicine!

Yes, I know it's hard. You feel like you work harder every year and make less money. Personally, I've only been in the solo game for 2 1/2 years now, so I've only felt a slight crunch, whereas those of you who have been practicing for more than 5 years have really felt the crunch. Unfortunately, I already started halfway down the reimbursement hill, but I do face the same struggles of keeping a practice afloat. Some of you got frustrated and left, and I don't blame you. After all, how does one keep going? Do I smell the ashes spelling B-U-R-N-O-U-T ? Well, at some point if you're a hamster on the healthcare treadmill, unless you're Lance Armstrong, you're going to get tired of it and jump off. It's no fun playing a game where you have no control over any of the rules.

So, how do you make it work for you?

Personally, I've decided the New Year will mean a rethinking of how I structure my practice. Of course, I should have done this from the beginning, but I was younger and not necessarily led in the right direction by well-intentioned physician colleagues. You see, the Healthcare Monster has created this perception that you need this and that to operate your practice, whereas perhaps you don't. These colleagues have been entrained to think this way. A biller, an extra medical assistant, someone to answer the phones, someone to call about referrals, and insurance plans having buildings full of ominous employees working to reject claims -- how is this supposed to control rising healthcare costs? It's like the Cold War all over. One side builds up its arms, and the other side is forced to build up its own in order to survive any act of aggression by the other. It makes no sense to me. Managed care actually lowered the quality of care, created more bureaucracy, and added to the toil of medical care. Somehow this was supposed to make healthcare more affordable? Well, of course it did, at the cost of quality.

Quality of life has been affected as well for both patient and physician. This year I plan to take back more of my quality of life. No, I probably won't work less hours, but those hours will be more fulfilling and have a higher yield curve as my overhead is slashed by a better-planned operation. After all, what do businesses do when they need to enhance their profits and tighten up their operations: sell off losing businesses and fire employees. What led me to the decision to downsize? Three things did: 1) the unjustifiably high cost of overhead, 2) the availability of technology that can automate many tasks that previously required that excess staff, and 3) reading this article about physician micropractices.

Even though my practice already has fulfilled many of the things I wanted to gain from being in solo practice, namely:
1) Autonomy,
2) Creating meaningful relationships with my patients,
3) Being able to give quality, compassionate care to my patients,
4) and Practicing medicine the way I felt it was meant to be practiced,
it still has a high operating expense because of the way I structured it.

Initially, I thought I needed all the bells and whistles, because a fellow physician that I share office space with convinced me so. Having no prior experience running a medical practice, and finding the referral/billing/ insurance bureaucracy overwhelming, I thought this was the way to go. Overnight, I found myself starting a fledgling practice while trying to pay an overhead I thought would be eventually justified when I got busy. I see no need for that anymore. I made a mistake, and I admit it. The lessons learned in the last 2 1/2 years are what are going to give birth to my new practice model.

The Micropractice:
1) Downsizing is good! That's right, even as small as one employee and myself. It will require multitasking, but it will also create a better patient experience as messages will not be lost, interactions will be more personal, and I won't be under the pressure of higher volume to maintain an out of control overhead.

2) Lower real estate cost. With downsizing comes less need for excess office space. Moving to a smaller office helps control costs. The article doesn't talk about this, but why be someone else's lease subsidy? Rather than sharing with another physician that is the lease owner, I will become the lease owner, and perhaps find another doctor to subsidize my lease. This makes more sense. No one ever talks about this.

Downsize the practice, too! That's right, lower overhead means less need to rush through patients, more time with new patients, and the ability to really get to know the issues troubling your established patients. These things cannot possibly be garnered in a 10-15 minute visit. Patients will be better taken care of, and your life will be less hectic and more liveable. I might even consider capping my practice, which I haven't done yet.

The Electronic Medical Record: automate, automate, automate! That is the name of the game. Make everything automatic, including billing. Why pay for a biller when a well-designed PM system can help you do it yourself. Modern technology has made is easier to achieve an ideal practice environment without excess staff. This year I will be adopting an EMR as part of my practice redesign.

Same-day Appointments are here again! Over and over, I hear patients calling other doctors complaining of a sore throat, only to be told the next available appointment is 3 weeks from now. Now how is this realistic? Patients need to be seen today for urgent problems, not 3 weeks from now when a simple cold could have turned into a pneumonia. Same-day appointments is the key feature of the micropractice that increases the quality of care for your patients. I have been able to do this already, but will use this as a key publicity point for my practice.

Filling a nitch. All of the above fulfill the need of patients to be heard, understood, and taken seriously. Patients want and deserve that regard. This is a return to how medicine should be practiced, not how They think we should practice medicine because of the need to power the out-of-control money-guzzling bureaucratic healthcare machine. The micropractice is a return to the traditional practice of medicine that patients have been longing for but didn't know how to ask for. Goodbye to the medical-industrial complex!

Offering an interactive website. This could be done through the EMR system. Offer online appointments and prescription refill requests. Create more informative content for your patients. This will attract patients to you, and will show your patients that you are devoted to and interested in what you do.

In 2007, I'm going to take back the practice of medicine. How about you?

Imagine what could happen to healthcare if doctors across the country created a network of low-overhead, high quality micropractices that banded together to purchase medical supplies in bulk, for example, at reduced rates. Wouldn't that control healthcare costs, I wonder? Topic for another blog entry.

and btw, Happy New Year to all!


Blogger The Independent Urologist said...

You da'man. Take back your life and your passion before you become one of those docs who complain, complain, complain.

5:40 PM EST  
Anonymous Bonnie said...

Congrats. It sounds like you've thought about the practice you want. I've done insurance billing on my own though, so beware of the amount of time that can take. You can outsource that by giving a biller a small percent of whatever is collected via the insurance and then you don't pay someone full (or part time) AND you and your assistant don't have to spend the time hassling with the insurance companies. If I have to do take insurance again, that would be the way I would go

3:12 PM EST  
Blogger ID Crossroads said...

Happy New Year! I've been reading your blog for a little bit. I'm intrigued by the idea of solo practice. Thanks for sharing your experiences. I just recently started my own blog (actually today!), I hope you don't mind my providing a link to your blog (when I figure out how to do it).

4:17 PM EST  
Blogger Medicine Man said...

Thanks for the cheerleading. I'm trying to make it work, but let me tell you there are days (like today) when I just want to throw in the towel. I'm trying to find a new space to move to, and that is a Herculean challenge. I feel squashed at the bottom of the reimbursement chain, making it difficult to find a space that would work financially while esthetically making it a soothing, healing environment. Aahh, the challenges never end!

5:41 PM EST  
Blogger Medicine Man said...

id crossroads:
welcome to the blogosphere!

5:42 PM EST  
Blogger akifox said...

Do I know you? Because if I don't, I should get to know you. I'm like the long lost (older) twin you never knew you had. Solo practitioner (FP). Started solo 2.9 years ago. Got a blog I call SoloDoc, which talks about how I'm doing the micropractice thing, too.

There is a website where like-minded doctors can share experiences/get advice about running their own micropractice. If you don't already know about it, it is located at:

Best of luck with your micropractice and blog. Hope to see you on the Practice Improvement listserve!

4:33 AM EST  
Blogger said...

This comment has been removed by a blog administrator.

6:33 PM EST  
Blogger Medicine Man said...

To First of all, I don't appreciate marketing spam on my blog, so your post will be deleted within 24 hrs. Secondly, sounds like your website is a lead aggregator. And no, you're not the only one doing this for doctors. Nor is lead aggregation the best way to market one's self. Also, as far as goes -- SEO (search engine optimization) is a costly and perhaps overrated alternative to other means by which to market one's website, with little ability to track ROI (return on investment). As far as I'm concerned, that's money thrown out the door. I will talk about these issues in my future blog entry: To or not! Part II. Marketing

3:42 PM EST  

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