To dot.com or not! Part II. Marketing

If you're going to have a website, then you should put it to good use for you as a marketing engine for your practice. But how do you do this?

Marketing your practice website is just as important as getting IT up and running with the right look, feel and user-friendly navigation. Without a marketing strategy for your website (i.e. your practice), your website might as well be stranded on a boat in the middle of the Sargasso Sea in the Bermuda triangle at night with no signal flairs, hoping that a passing plane will see it. No one's going to notice.

So let's begin with some definitions:

Website "traffic" = On the internet freeway, unlike when you're driving, you do want traffic -- lots of it. But you don't want just any traffic, you want the right traffic. Traffic = number of hits or "clicks" on your website link. However, random clicks mean nothing if they never become a new customer (in this case, patient) = "a conversion."

Number of impressions = In its simplest form, this means that when a person types in a search relevant to your website, in which your website happens to be one of the links that shows up, so it is perhaps seen as a link by the web searcher, but in the end the web searcher does NOT click on your website link. In the industry, they say this leaves an "impression" on the potential customer, so they may come back to your website in the future. For this particular type of search (or "window brousing" as it may be likened to), it is the branding or wording of the search ad for your site that hopefully makes an impression to which the person will want to return.

Search Engine Optimization = SEO, the process of increasing traffic to a website usually in a "natural" or "organic" fashion in the search results page. This means a website appears in the non-sponsored links, so that this distinguishes it from pay-per-click marketing, which is based on keyword bidding. This is a term used very commonly by most internet marketing companies as a service they provide, usually at a monthly cost, for your website, by which they insert metatags that try to trick the search engines to pick up your website "organically." This may also involve improving the site's coding, presentation and structure to make it easier for the search engines to pick it up. The problems with this system is that it's more difficult to keep track of conversion actions (actions people take that make them a new customer or patient to you), and there is no guarantee because Google is constantly changing the algorithm formulas. For example, you may have first page placement one month, then 5th page placement two months later. It's a constant and possibly costly battle.

Pay-per-click marketing = a blind auction for which businesses have set that they are willing to pay a certain price for certain keywords to drive traffic to their websites. These are the sponsored links that appear at the top or to the right of the page.

Lead aggregators = these are websites that market themselves on the search engines to obtain leads for their members. This shifts the risk away from you in a sense, to the lead aggregator, but may do so at a hefty price. In other words, lead aggregators become a middle-man in the contest for new business leads. In this setup, your profile is listed amongst all of your competitors, making it harder for you to distinguish yourself. In some cases, they may duplicate leads. Each lead aggregator is set up differently. Read the fine-print before committing.

Conversion-based optimization = another fancy term, which means keyword optimization based on the specific keywords that are generating leads for a business. This is possibly the most complex type of optimization offered for local search, and there is only one company that created this technology and brought it to the local level for small to mid-sized businesses to take advantage of, and that's Reachlocal.com.

Search engine marketing = the catch-all phrase for describing efforts to increase the visibility of a website in search engine results pages.

Oh, and I almost forgot...

ROI = Return on investment. We're going to get to that below.

Now for the reason you should know about these terms and why they are important to you as the 21st Century business owner:

A recent article in Entrepeneur magazine's March 2007 Issue highlights the growing importance of local search as a marketing tool for all types of businesses. The internet has become the 6th sense. It's the way a new generation experiences the world. Before going for services, more and more people are searching on the internet for local businesses that meet their needs.

There are different ways to glean the benefits of the local searching surge that is predicted for 2007 and the next few years.

1) Google Adwords = choose your keywords, create an ad for google search, choose a budget (you don't even need a website) and off you go. You have to keep track of how people found you so you can know if it's working (i.e. ROI). You can do this on your own, or this may be part of a marketing package sold to you by an IT company. Results are not guaranteed.

2) Local search listings = search engines, like Yahoo! local, where you can place an ad. This is the equivalent of an online yellowpage listing, known in the industry as IYP = Internet Yellow Pages. This makes up only 2 -3% of where web surfers are making their searches. Yahoo! local is an IYP, not to be confused with the Yahoo search engine. Citysearch is another infamous IYP. They were built on the basis of nightlife and restaurant listings then expanded to other services. The list rankings on citysearch which used to be based on reviews are now really based on spending. Citysearch is now promising its clients listings on google and yahoo searches, but you have wonder how they will spend your money as an additional middleman. Again, where's the ROI? The majority of search, that is 70%, are done at the main Google.com and Yahoo.com webpages. So you see, the majority of the traffic is not here. Choose your battles!

3) Lead aggregators = we spoke about this above. This is a fancier version of a local search listing, where they are going the next step and promising leads. In most cases they are working for you and your competitors simultaneously. So who's interests are really being met here? Citysearch, according to their website, would argue that they are a lead aggregator, but they're not really.

4) Bucket-of-clicks = another method used by a middleman company that for lack of a better term will buy cheaper clicks (i.e. bottom of the barrel clicks) then inflate the price significantly and charge you a flat rate, promising volume of clicks with little known value. In this case, quantity (i.e. website traffic) does not necessarily equal quality (new business conversions & the uberimportant ROI). Ex. beware of companies that say, "For $300/mo we promise you X amount of clicks." Quantity ah! ah! ah! Does not equal Quality!

5) Pay-per-click marketing with conversion-based optimization = this is the Mother of all local search. The best analogy from a business-owners perspective is that if you knew what keyword(s) or combinations thereof were actually making the phone ring, your natural inclination would be to maximize your marketing budget on these particular keywords to bring more business to your doorstep. It's the only local search marketing strategy that shows tangible ROI. And there is only one company that has the software that can do this for the small to medium size business -- Reachlocal.com. The marketing budget is taylored to your industry and the competition or cost for your business-relevant keywords. So the budget varies based on how competitive your market is (that is, keyword pricing is industry-driven by how many businesses are competing for keywords) and how competitive your business wants to be. Your budget here determines how often and how high up in the sponsored links you will appear. The software is smart in that it figures out how to optimize your budget, wherever you are. ROI is tracked by a proxy server with proxy pages for each of your webpages that can track web events, such as form submissions or calls generated to your practice from the reachlocal-powered search. You get daily or weekly reports showing the performance of your current marketing campaign with more information than you will get from any other service. The focus here is on results, REAL results = ROI. So there you go, pay-per-click marketing with conversion-based optimization in a nutshell. I guarantee you'll be hearing more about this in the near future.

6) SEO = see above. This is the organic way to market yourself. Results are not guaranteed.

In Conclusion:
Do I recommend any of these? Well, I've tried to provide a broad view of what's out there and where you should be. Where you end up is dictated by your budget and your level of comfort with these terms and the utility of these services. But if you have to ask, the Tao in me would say take the holistic approach = choose #5, get yourself listed for free on local search sites and maybe mix it up with some SEO if it works in your budget. Good luck!

To dot.com or not! Part I (of a 2-part series).

Can a Primary Care Medical Practice exist without a dot.com presence in 2007?

While advertising dollars in other industries have recently fallen or failed to grow, as per an article in the Wall Street Journal about a month ago, internet advertising dollars have grown exponentially, thanks to the many means by which to advertise on the internet at a fraction of the cost of print and other media. Google adwords is one example. And the fact that more and more people are searching locally (i.e. using google, Yahoo!, MSN, etc...) to find services, should hint at the fact that having an internet presence is probably key to a practice's survival and growth. Can a practice grow without it? Yes, a friend who is an allergist has grown a successful practice in 2 years without a website for his practice. However, a specialist relies on referrals from established doctors with established patients. A primary care doctor, however, is where the buck begins, so primary care docs have to attract patients by creative and unconventional means. Eventually, word of mouth takes over, but initially, establishing oneself on the map (outside of being the only primary doctor within miles in some rural community) takes creativity. Does primary care have something to learn from more business savvy specialties, like plastic surgeons, dermatologists, chiropractors and cosmetic dentists?

These specialties have prominent online presences. They have fancy websites with a broad description of their services. The fact of the matter is that nowadays, having a website legitimizes the existence of a business (i.e. your practice) in the eyes of the Internet Generation. Personally, I particularly like to check out a business's website before venturing over as a customer. This is a growing trend in this increasingly tech-savvy world. The website is their first taste of your business. A well-planned website saves the browser time in setting expectations. A poorly-made website can be a killer for potential new business. People use them to choose vacations, book airline tickets, find music they like, and explore the world around them. Increasingly, websites have become people's extra set of eyes by which to explore the world around themselves, including the world of services.

Why you need a website:
A website is the modern business' Yellow-page ad. The internet is where people are searching for services. A website is the natural next step in the path towards making your practice more technologically advanced, more automatic, and more friendly and informative to your future tech-savvy patients. On your website, you can really tell potential new patients what your practice is all about so that you attract the right type of patients to your practice. You can provide free public information. You can create links to other informative medical websites. You can feature a full description of the services you provide. You could attach a blog to the website. You can generate a newsletter. You can offer registration forms for downloading to speed up the registration process. You can even create email links for new patients to request an appointment online. By far, it is a better voice for your practice to total strangers than you can provide for yourself, outside of taking good care of your patients so that they go out and talk about you.

Creating the website:
Creating the website is a challenging task. It's much like buying a home and decorating it. You need to decide on a number of things, including a domain name, a company to host your website (where it sits on a master computer for others to access and view on the internet), color, feel, navigation (how to get around the website), what information you want to include (like for example, your address/ hours and your qualifications). Or you could simply hire a web designer and leave it up to them. However, being that your website is a direct representation of who you are, I would personally be involved in its design, look/feel and content. You might even want to have a lawyer help you put a disclaimer together for the website, explaining that the information on the website is not for treatment purposes. Let's face it, you've got to cover yourself from possible litigation in lawyer-happy America.

There are a plethora of graphic designers and companies in the market. You can also select a premade template (i.e. a website skeleton) and work from there. Choosing either may be a difficult task. Ultimately, cost calculations will come into play. You can even design your own simple website by learning html (it's really not that hard). However, for a fancier version that will be appealing to potential new customers, expect to spend in the range of $1500 - 2000 on the low end and up to $4000 - 5000 at the high end. Getting a designer, I believe, is worth the money. Your website, unless you have advanced html experience, will turn out better. And afterwards, you're not going to have the time to maintain it yourself or troubleshoot any problems. Interview several designers/ design companies, compare prices, and ask for samples of their work and even to talk to prior customers.

In summary, in order to create a website you need to:
1) Choose a domain name (i.e. www._______.com/net/org) to represent your practice and see if it's available, then register it. There are many websites that can help you do this. My favorite is Godaddy.com (just because I like their commercials).
2) Choose a company to host your website. (Plenty of these online)
3) Decide on look/feel and how you want it to navigate. This is the point where you should go surfing the internet and find as many doctor websites as possible, comparing them and learning what you like or don't like about them. This will help you zero in on your design.
4) Consider designing a logo for your practice to begin branding its presence in your local community.
5) Decide on the information you want included and start writing it out.
6) Choose a web-designer, or design it yourself after reading a book on designing a website or attending a course if you have the time. In choosing a designer, ask your peers or interview several prospects and ask for a sample portfolio and references.
7) Go live. Make sure the website works on all the internet browsers. (The main ones are Internet Explorer, Mozilla Firefox, and Apple's Safari).

After your website is done. Now what?
So now you're online. You've finally claimed your piece of internet real estate. Hurray! You're done, right? Wrong! Building your website is only the beginning of the game in getting new patients. For those not familiar with internet jargon, there's traffic to your website (a.k.a. "number of hits," "clicks"), number of impressions, search engine optimization, search engine marketing, page-ranking, pay-per-click marketing, and lead aggregators (like LocateADoc.com). Now you have to vie for the piece of online real estate that puts your website in front of potential future patients. And finally, there's another big word and the most important word in marketing: ROI (i.e. return on investment). More on these in Part II of this series.

The Tao of Starting a Practice.....

Starting a practice is not easy, and as a series of very realistic posts over at The Independent Urologist demonstrate, there's a lot of new understanding required to achieve success in private solo practice.

Besides understanding cold-hard numbers and facts, I've found that a little Tao can go a long way towards helping a young practice grow. Just like a small shrub in the forest, there are plenty of reasons for a small practice to fail to thrive, including getting trampled by the competition. However, with a little positive reinforcement, the small practice will grow into something you can really come to enjoy. The first few months are primarily a mental challenge in strength, resilience, and confidence, with doubt, weakness of resolve, and the inability to pick yourself up again when you think you've failed being the enemies of success. Nobody's ever made it who hasn't stumbled on their own footsteps multiple times. Things won't be perfect, but they'll be your own. There's nothing that can replace being at the helm.

So here are my little Tao principles for making the practice work:

1) When the phone is not ringing, organize your desk.
Transform your anxiety into a positive action. Organize your contacts. Call them. Reach out. Go to networking functions. Don't just sit there. Send your established patients a newsletter. Or even a thank you for being your patient. Get organized, and that phone will start ringing again!

2) When your weekly numbers drop, let go of controlling your practice.
I've found this to be true from the beginning. There's an energetic loop with the flow of patients. The more you want to control your weekly numbers the more they bend away from you. Yes, I know this goes against the mathematical explanation of regression to the mean, but this is the Tao of practice. Your mental state will influence your outcomes.

3) When the checks slow down, visualize the free and easy flow of money.
A little Tao dictates substituting negative thoughts with positive visualizations. The more one hords one's money, the more one constrains it. If no one spent any money, then there would be no economy. It's the flow that keeps things moving. Getting into the mindset of the flow frees you from the constraints of counting the daily numbers. Things always balance out somehow.

4) When you can't sleep at night because of worry, breathe out the worry and breathe in visions of success.
Success is already around the corner. It's out there for the grabbing, but spending too much time worrying is going to alter what you do for your success. A little worrying is ok, if it motivates you to action. But too much worry is an energy drain that does not benefit your practice. So breathe out those worries, and breathe in your success.

5) When your practice doesn't feel ideal anymore, find your center.
It's when you are centered that you truly know what your ideal practice is. If you've strayed from this point, don't fret about it, just find your center again. Write about your practice -- how it is, and how you want it to be. Just write. You don't have to have the answers right away. Writing this out, your subconscious will start working on those answers that will wake you up in the middle of the night with a "Eureka!"

6) And finally, the ultimate Tao: Keep yourself healthy and balanced.
Keeping yourself healthy and balanced, will keep your practice healthy and balanced. Many doctors sacrifice their own health in service for others. Although altruistic, eventually this will catch up with them. A significant portion of doctors suffer from depression or substance abuse. So take time to keep a healthy mind in a healthy body. Meditate. Exercise. Eat heathily. Keep your system clean. Plan Spring and Fall detox diets. Keeping yourself balanced will make you a better doctor. If you have extra free time because your numbers are not up yet in the early years, don't fret about that either, go to the gym or spend extra time with your family and friends. Enjoy the ebb and flow of life.

The Solo Practitioner gets quoted in national newspaper!!

On the Friday, February 23rd edition, the Wall Street Journal ran a a front page story by Gautam Naik talking about the use of technology in the creation of a new type of medical practice for the primary care physician -- the micropractice. The main reasons for this are: 1) technology reduces costs, 2) reduces need for superfluous staff, 3) possibly eliminates the need for a costly biller (a creation in response to insurance bureaucracy) and 4) improves quality of care. The enhancements that technology adds to a practice are endless, and include electronic prescriptions, summaries of medical visits for patients, printable patient education, tracking of patients who are due for lab or health maintenance services, creation of a newsletter, and diagnosis-specific mailings to patients. How great is that! Technology can only do good for patients. And for the primary care physicians in this country, technology has come to the rescue at a time when inflation-adjusted income for this backbone of the medical profession has dropped by 10%, whereas specialist income has at least kept up with inflation. The micropractice is the answer to some of the woes overworked primary care docs face in the insurance-driven big-practice factory-style medicine machine this country is pushing its doctors into, but will inevitably FAIL!!!

So, to toot my own horn, here's the quote: "Automate, automate, automate! That is the name of the game. Make everything automatic, including billing."

The truth is where medical practice is going now with the micropractice and concierge medicine is that primary care doctors want to feel human again. The days of sacrificing our lifespans to take incomplete care of dozens upon dozens of patients are coming to an end. Seeing 30 - 40 patients a day, intercepting many more phone calls, writing innumerable medication scripts (which is what the insurance companies would have us doctors due in this current healthcare treadmill) is NOT within the human possibilities of primary care practice WHILE STILL PROVIDING GOOD CARE. Doctors, contrary to popular belief, are not superhuman. The truth is when you work that fast, you know you're missing things. You know you're not providing good quality care. Would you want to be a patient of someone operating in this model?

THE MICROPRACTICE FREES DOCTORS:
So the doctors that are choosing the micropractice model, which has a lot of similarities to the concierge model, are choosing it to practice GOOD MEDICINE again, that is also ENJOYABLE. Cause guess what, having to rush from patient to patient all day long (in 10-15 minute visits) and field call after call after call, is just not fun. It leaves you feeling inhuman. And someone who's feeling dehumanized cannot possibly provide good care to other humans. Lifestyle is once again important to doctors. We're going to fight back! And the micropractice model is just the beginning. Unfortunately, this model still functions (to some extent) within the confines of insurance payments. The best medicine would be practiced outside of the insurance umbrella dictating access to procedures and medicines and such; instead, using evidence-based care and quality of results as the rule for dictating care.

IS UNIONIZING THE NEXT STEP?
And last, but not least, beyond the micropractice, primary care doctors across this country should form a national union. Not to ever strike (for that would be unethical), but in order to form a unified, and very powerful bargaining voice with the insurance companies. As individuals, we lack power, but together we could really put a check on the insurance companies that now rule our profession with little counterbalance, other than costly and timely court proceedings (like the ones in Florida for price-fixing). In addition, a national union could lower the cost of supplies by purchasing them en-mass for its members, then reselling at a discount. A national union of doctors would actually help control the burgeoning cost of medicine in this country. The only true threat of disruption by a national or state-wide unions would be to the insurance companies. Doctors could now go to the insurance companies as a whole to meet their demands, or warn that all union members would drop that insurance plan. An insurance company without in-network doctors would suffer greatly. Patients will still get reimbursed for out-of-network care. The proposal is for a checks and balances between the insurance companies and doctors. Right now there is none, and doctors have basically sold their souls to the insurance companies for fear of losing patients. THIS IMBALANCE NEEDS TO END!!!

Concierge Care: Is it the answer?

The "concierge," "boutique," or "patient-centered" model of medical practice is drawing a lot of attention these days. Doctors that are discontented with the way the medical system works are deciding to drop out of the insurance picture and repaint a kinder, more time-friendly scene for their patients with increased access (like giving out their own private cellphone number). In effect, from an individual perspective it is wonderful, but its critics challenge that it's going to aggravate the impending doctor shortage. But will it really?

In 2005, the Government Accountability Office reviewed this growing trend for concierge medicine. They decided at the time that there were not enough concierge docs to affect access to care, yet. If that is the case, I wonder what they will do. Will they make it illegal to practice this style of medicine? Will making it against the law not continue the trend of growing dissatisfaction and doctors leaving medicine, thus the path to a physician shortage?

Here's another question. If doctors choosing this practice model are happier overall, providing higher quality, more compassionate care, wouldn't that increase the number of physicians wanting to become primary care physicians, because of a renewed chance for job satisfaction in this specialty? After all, why are more and more residents choosing subspecialties? Is it because they love that aspect of medicine, or it is also because they know that it offers greater monetary rewards? Let's be honest, for as much as society would like to believe that people become doctors to help the greater good, doctors still have to live in the practical world of paying for their living and for their other dreams, which may include owning a home, having a family, being able to take quality vacations, or pursuing a hobby or outside passion. Doctors are no longer the unidimensional workers they once were. People have varied interests, and having quality of life is becoming ever more important for the coming generation of doctors.

The other argument against concierge care is that it creates a stratified healthcare system, providing the best care to those that can afford it. This is a tough one. How do you argue against that? Unfortunately, everything else in society is stratified. Not everyone gets to eat in the best restaurants, fly first class, own a large home, go on a yearly vacation.... the list goes on. Come on, our society is stratified by money. That is what capitalism is all about, because even the poorest can make it. Whereas in a communist system with universal everything, the poorest stay poor and the rich stay rich. Does this justify it? Hey, one's health is an investment. The same people that don't want to pay for it are out there buying ipods and xbox's and paying for plastic surgery. Where there's a will, there's a way. It's just that America's values are skewed. Government could provide low-income housing and further tax breaks so that the lower class and the lower middle class could afford their healthcare. The old model simply doesn't work, because healthcare dictated by those that are trying to not pay for it (i.e. insurance companies) just doesn't work.

So what should the emphasis be with patient-centered care? Well, make it a true patient- doctor alliance. Concentrate on preventive care to save the healthcare system money. Allow time to create a plan of action and educate patients on how to take good care of themselves.

Is concierge care the answer? In many ways it's a better model than what has developed in the current system. The current system thinks that doctors are some incredible superheroes able to take care of a multitude of problems in minimal time. This is simply not possible. Good care does NOT happen in a 5 minute visit. Even a 15 minute visit is pushing it for patients with multi-system problems. Concierge care brings reality back to medicine. Insurance companies have corporatized medicine beyond human capabilities. Concierge care is humanizing it again. I'm trying to find the answers, and concierge, patient-centered care is very attractive. Let's make the patient the boss again, and work for them, instead of the insurance companies.

And until I convert, I'm following the low-overhead micropractice model to make this process of building a practice from the ground up more palatable.

Is there a solution to the medical practice woes?

A fellow blogger, conciergedoc is giving us a fresh perspective on starting a concierge practice. Wherein I wrote in January about the micropractice, a low-cost alternative to the healthcare conundrum = rising costs/ falling reimbursements, the Concierge Practice offers another solution to this mess. The polls say doctors are depressed and unhappy (see Physician morale on shaky terms), but honestly, it doesn't matter what the polls say, no Internist or PCP I've spoken to across the entire country is happy with the system. No doctor has ever reported to me, "I love this. It's great!" How can you, when you're being skr@$ed every day by the insurance giants. Perhaps those in concierge medicine would sing a different tune. Personally, I've thought of all possible solutions, including a concierge conversion.

Currently, one of my doc friends on the West coast is converting his practice to concierge. It isn't easy, and no matter how great it is and how wonderful the promises, as conciergedoc points out, people are not yet running in droves to sign up for concierge care. It may not even be overly expensive, but the population mass has been educated to believe that healthcare should only be about copays, forgetting the fact that they may be paying several thousands per year for their substandard healthcare. It's all been a marketing victory for the insurance companies with their ever-expanding financial base. To be fair, they have created access. But again, like I've said in previous posts, Access =/ (does not necessarily equal) quality.

In this case, concierge doc's have created a system to make medicine more palatable for both parties. This is the same way for the micropractice, except that the micropractice physician still agrees to work within the system, by cutting operations to bare bones (Is it right the system has forced this upon us?), so as to become profitable on diminished returns. It's like a damaged airplane dumping fuel to increase the chances of a safe emergency landing. Ok, perhaps that is overly dramatic, but it may not be the best solution in the long-term.

For now, the micropractice may be able to somehow function within the quagmire of insurance codes, but what happens when they tighten the reigns, will the micropractice run into jeopardy at some point? Will the insurance companies never-ending ploys to NOT PAY, require the inevitable addition of a billing specialist to the practice payroll, thus reducing the functionability of the micropractice? Or will it be inevitable for the micropractice to join their concierge colleagues in providing essentially the same-promise of a Norman Rockwell-style medicine independent of the concerns of insurance payments.

Is there an in-between solution? Well, many doctors don't convert to concierge, but decide to go Out-of-network on certain insurance plans -- usually the ones that pay poorly. By going out-of-network, the patient has to pay until they meet their deductible (which may very well be in 1 -2 visits), then they only pay an agreed upon percentage of the total fee (say 20-25%). The kicker is that the insurance contract forces the insurance company to cover the other 75-80% of the billed amount. There is no such thing as "allowed" amounts! The insurance company has to pay what is billed, and that's that. So why aren't more docs going out-of-network? Probably because they fear their patients will leave them for the doctor next door still accepting the plan. This brings us back to what we can learn from concierge practices. You have to provide another level of service and commitment. This promise and the ever-important old fashion doctor-patient relationship is what will keep patients coming back.

Which one is the right solution?
1) Micropractice
2) Concierge practice
3) Cash practice/ Out-of-network

I'm not sure. Each has its own hurdles and potential set-backs. But I imagine that the happiest doctors are in 2) or 3). Let's face it, getting paid 6 months after you performed a service just doesn't cut it. Medicine is in crisis in this country, and the federal government may not be the one to solve it. Perhaps the way to bridge the problem of the lower half, the uninsured, while providing the greatest physician satisfaction (something law makers don't seem to be very concerned about) is to follow the Dr. Vic Wood's model. Would this solve the nation's health problems? How about low-cost primary care clinics throughout the country, with universal healthcare providing catastrophic coverage for hospitalizations and more complex issues, but the simple stuff left to the doctors, who can then benefit from providing good care.

How I ended up here, I'm not sure, but I'm just trying to find a solution for my medical practice woes. Perhaps the solution that can help the rest of the country is the one that makes BOTH doctors and patients happy. As it is now, the system is BROKEN. And unless I find some solution for my own woes, I may be tempted to leave medicine all together.

The Search goes on.......

And the search goes on for the new office space. Yes, it can be a frustrating affair. Questions, like "Will my patients follow me?" come up on a daily basis. Will the new space be right? How big should it be? How small should it be? It seems that the just-right Goldilocks space is hard to find.

At some point, you might just have to jump in without testing the waters to see if they're too cold or too hot. For a risk-averse doctor as myself, the big question with every space being so expensive, is should I take the risk of getting a space that's bigger than my needs then finding some like-minded practitioners to come in and share the rent burden or just find something I can afford myself, but pay a bigger portion of the rent? It's a tough gamble. But if taken successfully, this large space gamble could result in the best-case scenario for everyone involved.

How primary care got so beaten up is beyond my understanding. But faced with falling payments year after year, I'm surprised more primary care doctors have not opted out of insurance plans. So here I am, unfortunately, a product of those that abdicated the fight before me, hoping to make enough money to pay all of those who stick their hands in my pockets (like my malpractice carrier) before I do. Creativity is the name of the game. And the first place to start is with a new space and a new rent -- hopefully a lower one. Let's face it, the one thing we have the ability to take control of is our overhead. I can't bargain down my malpractice payments or share them with someone else if I've been good.

So the hunt goes on for New Space -- new overhead and a new beginning to make the business of medicine less-burdonsome so that I can spend more time doing the fun part -- being a doctor.

If there are any primary care doctors out there, please share and express your opinions on this topic in the comments section. I would love to hear what you have to say.