Wednesday, December 17, 2003

Less filling, tastes great

Yesterday I ordered some office furniture from Plummers, which is slightly more upscale than Ikea. Since my office is really small (an 8 x 8 foot room), I had to make sure everything fit and optimized my space. It isn't the cheapest stuff, but also not the most expensive. It still came out to about $1500 though.

A recent article in American Medical News talked about getting seed money to startup new practices, and the consultants in the article gave figures of up to $150,000 in startup costs for a solo family physician. Yikes! I'm more like this guy. It depends what kind of practice you want. I'd rather have one that's less filling (than tastes expensive).

Countdown: 19 days until target start date

Monday, December 15, 2003

Old fashioned values, 21st Century gear

Things are progressing as I slowly move towards opening my solo practice.

I started moving in a week ago, much to my pleasant surprise. I thought the acupuncturist might end up staying past his 30 day notice, but he did not. The sink fit, but the carpet got soaked from the installation. No matter, as that is going to be replaced.

The cable installers came today, and installation was a breeze. I assigned myself an email address to be used exclusively with the practice. I had originally thought that HIPAA required that any email communication had to be via a secure encrypted server, which meant going with a free service, like the ones offered by the California Academy of Family Physicians or by Medem. Or you could pay $50/month for secure email through RelayHealth.

The problem with CAFP's site is that it is not fully compatible with Macs (my platform of choice), so I and my Mac-using patients would be left out of some functions. Since I am in California, I hope that CAFP can fix the website to allow full functionality for Mac users. In fact, I'm going so far as to volunteer to be on an advisory committee on technology issues for CAFP to make sure that it eventually comes to pass.

Medem is advertiser-supported, meaning your free website has to display ads, unless you choose the non-sponsored version which costs $30/month. The email service is called an "online consultation" and permits physicians to charge a fee if they want to or not. My reading on the subject so far has been that very few patients are interested in paying for email communication (or phone calls) with their doctor.

RelayHealth looks like a great site and I have used their eScript prescription refill service at Kaiser. It works well. But they do charge quite a bit, basically $600/yr. If I ever consider hosting my own website, maybe I'll consider them again.

My interpretation of HIPAA is that while secure email is best, unsecured email is permitted as long as you disclose to the patient that this form of communication is not totally confidential, and that as long as they understand this and agree to this avenue of communication, then a physician is not going to be penalized for using regular email. We'll see how well things work.

How will I get patients in my new practice? I hear this question a lot.

Word of mouth, of course. I am getting more and more requests from people/friends as to when my practice will start, and what kind of insurance I will take. We had a Christmas party last weekend, and one friend said she already has 5 families lined up for me whenever I'm ready. I even handed out some homemade business cards my daughter made on the computer, just so people could get the word out.

One of my daughter's friend's father is a graphic designer who just recently left a big graphics design firm to start his own business (just like me!), and he offered to help me design something for free (although we eventually agreed we would barter his services for a complete check-up). He showed me his designs today for identity logos which blew me away with how professional they looked. To paraphrase an old movie line, "I could be somebody!" with business cards that looked like they belonged to a Fortune 500 company, rather than a one doctor operation in a small suburb. The hard part will be trying to decide among the 6 great designs he came up with and choose which one will represent me.

Email. Business cards. Logos.

It is all part of an image I will be trying to present to my target population. That of a caring, community-oriented, small-town family doctor who is also extremely accessible and technologically savvy. Old fashioned values, 21st Century gear.

Countdown: 21 days until target start date

Monday, December 08, 2003

What's in a name?

I got the keys to my new office today. I guess I should say, our new office. I am sharing a 4 room suite with a psychologist (my landlord) and a chiropractor, who each have one room. I have 2 rooms. Two *small* rooms: a 9'7" x 9'5" exam room and a 8 x 8 foot windowless room, which will serve as my office.

The pedestal sink I bought was incompatible with the plumbing fixtures, so the landlord and I made a quick trip to Home Depot to buy a cabinet style sink which looks just fine. There are holes in many of the walls where a bunch of cabinets used to hold large quantities of pungent and bitter-smelling Chinese herbs. The landlord said that he and the chiropractor both lost patients because of the smell, so he is glad that I am moving in.

The landlord also kept telling me how busy the previous tenant, an acupuncturist, was. But he chose not to renew his year-long lease, instead going on a month to month lease. That was what enabled me to take his space, because the landlord wanted a tenant with a long-term commitment. I'll try not to make that mistake when my lease renewal is due. This is assuming my practice is a success.

What to do next? I have to get furniture for my tiny office, and chairs. Bookshelves. I don't know how I'm going to be able to fit everything in my office, since I would prefer not to leave anything out in the common area, at least nothing of significant worth. I know my wife wants to have some say in the color of paint, and wall decorations.

A major project will be ripping up the carpet in the exam room to lay linoleum tile. This is to allow for easier cleanup (and a more sanitary environment) just in case someone has an "accident". After all, besides being my own nurse, receptionist, biller, and office manager, I also will be my own custodian.

I also have to figure out how to fit a refrigerator/freezer in to store my vaccines.

And business cards. And newspaper ads. And business stationary.

The phone installer is coming between 8AM-5PM tomorrow. Talk about a "narrow window". Good thing I have the whole day off. And the cable installer is coming next week to hook me up for cable modem internet access (which I've found to be faster than DSL for home use; plus I hate the local phone company that provides DSL service).

A lot of things to juggle. As a family physician, I am used to that.

The landlord asked me how I wanted my name printed on the signs outside. "No middle initial?" he asked after I told him. No, I preferred a simpler identity. First name, last name. M.D. But then I wondered what to put after that. "Which sounds better? Family Practice or Family Physician?" I asked him and his wife.

I had recently read about the American Academy of Family Physicians voting to rename the specialty "family medicine" instead of "family practice" ; and "family physicians" instead of "family practictioners".

"While it may be semantics to some, perception is everything," Lindholm said. "I specialize in family medicine. If our own colleagues in medicine don't understand that we're specialists, I don't think our patients can (understand), either."


It is something all family physicians have to put up with, I think. Our patients don't know what kind of doctors we are. Many assume I am an internist, or a pediatrician (when I see a child), or a general practitioner. This mirrors the findings of focus groups questioned by the Future of Family Medicine Project, which found that a third of patients who saw a family physician didn't know their doctor was a family physician.

The landlord and his wife both thought "Family Practice" sounded more familiar to them, so I told them to put that after my name on the sign. But now that I think about it, I would rather be known as a family physician than a family practitioner. Time to think different, just like my solo practice model.

So tomorrow morning, i will call the landlord and tell him to put "Family Physician" after my name. Because that's what I am. And proud to be.

Countdown: 28 days until target start date

Sunday, December 07, 2003

An end (and a beginning)

I did something yesterday I had never done before. I attended the funeral of a patient. Except that Charlie was not exactly a patient in the usual sense.

At Charlie's funeral, a crowded affair at his Mormon temple, I learned some things about this man whose life briefly touched mine. He was a devoted family man with 5 children, very active in his local community helping out with T-ball leagues, was very spiritual in his faith. He worked as a mortician, which struck me as somewhat ironic. The many stories and remembrances shared by his family and friends reminded me that we tend to lionize those who pass away, and yet I wondered if I could ever be as good as man as Charlie seemed. I suppose even the most accomplished person still has some regrets when he/she dies.

After a period of waiting, things seem to be rolling ahead again with my solo practice venture. The current tenant of my future office space is indeed moving out on time, and I hope to be able to start moving in starting tomorrow. I bought an inexpensive pedastal sink at the local hardware store for less than $100 to be installed in the one exam room, and a handyman is scheduled to install it tomorrow.

I had been told by the malpractice insurance agent that I had been approved for coverage last week, but still had not received the official notice yet. That was because they had mailed it to my future office address, and I did not have access to it yet. Luckily, the landlord held the letter for me which I opened today. Surprisingly, the annual premium was less than what I expected, about $5000 for the first year. It will go up gradually every year for 5 years, as I increase my patient panel (and presumed malpractice risk). I have to mail back a check and then I will be covered.

I finally received my EMR program last week, too, after ordering it a month before. First it was delivered to the wrong address. Then by the time I got the disc it turned out to be the version to upgrade the program rather than the software for a new installation. I have been playing around with it, but of course, I won't really know how well it flows until I start charting a real patient encounter.

I've ordered some hardware. A Palm Tungsten C loaded with Epocrates Pro, InfoRetriever and some shareware medical programs. I have a demo of Bluefish Rx, too, which is a prescription writing program. It allows printing and faxing of prescriptions, but I think it costs $20/month for the fax service. In the interest of keeping costs down, I think it will still be cheaper to handwrite prescriptions for a while. But the *Wow Factor* of being able to fax prescriptions from my PDA is certainly intriguing and fits into my model of a smalltown practice utilizing 21st Century technology.

I bought both a black and white laserprinter, and a multifunction inkjet color printer/fax/scan/copy machine so that I could save on some space, which I won't have a lot of in my new (small) office.

I hope to finally start moving in to my new office space tomorrow. Such is the natural cycle of life. Some things come to an end while other things begin anew.

Goodbye, Charlie.

Countdown: 29 days until target start date