Sunday, February 29, 2004

Solo is Beautiful

OK, I've been in practice for a little over a week, my first ad came out 4 days ago, and I've only had one phone call from a potential patient so far. Time to worry yet? Not according to other doctors who've gone through opening their own solo practices before me.

From the Practice Improvement Forum, a forum for physicians trying to improve their clinical practices, Jim, a family physician in Kansas, commented on his experiences when he opened his own solo practice:
"I had a part-time job so that I was rather deliberate in setting this practice up. I had a good business model except for a specific marketing plan. I thought that was too difficult and that the pressure to find good local physicians would naturally drive the process. I was wrong.

I had not solicited patients at my last job because I felt uncomfortable doing so. I did take names of people who asked where I would be so that I could send announcements to them.

After I set up my practice up, I watched the phone. It did not ring. Very. Often.
Time went by and my increasing anxiety and deteriorating financial situation opened by mind towards marketing."

I'll be happy when the number of phone calls from patients exceeds the number of phone calls I get from telemarketers.

John, a family doctor in Virginia, opened his practice in April 2003:
"I assumed the patients would be beating down the doors when they heard about what I was doing. That did not happen, and so I had to turn more to marketing than I ever thought I would. With that said, I did recently talk a reporter into doing an article about my practice in the local paper (she is mainly interested in the home visits, but I feel its all a package deal). I believe that will be the push I need to get over the hump.

Everyone that comes here loves it, but our growth has not been anything like has been suggested either. People are interested and we are growing, but it has been slow."

And the newspaper article on John did come out, although you have to register in order to read it (but you can just enter fake data).

Nancy, a family doctor in New Mexico, wrote:
"It still has taken 6 months to come close to filling my panel. I wasn't really busy on an everyday until 3-4 months after I went fulltime. Word of mouth takes a while, and getting around to seeing a doctor, even a good one, isn't always high on people's lists."

So that's what it looks like at the beginning of the process. Here's what I hope to find later on down the road, as described by Josie, another family doctor in Virginia, after 5 months of solo practice:
"Here's what I LOVE about my practice:

I choose my own schedule. Not only when I work, but whom I see and when. I decide on a case-by-case basis when and how to fit people in. (Well, I can't control those walk-ins...but otherwise I know what's coming, and what the problems are).

These are very much MY people. I'm not seeing them for another doctor. I take care of them in a much more direct and complete way than I used to. I find great satisfaction in setting up a referral appointment immediately, calling the drug store to find out the name of the "little pink pill" while they're sitting there, etc. I don't have to track my nurse down because there is no nurse. I have the luxury of time to be able to take care of those things now, and the patients love it.

Call is not onerous. I get about 10 calls a week, all of them appropriate, and almost never when I'm asleep. Sure, my practice follows the 80/20 rule (80% of the call from 20% of the people), but since they're not some other doctor's people, and I know them, it's quick and easy to take care of the calls.

My patients walk into my waiting room, which has a comfy couch and big over-stuffed chair, and a giant stuffed dragon for kids, and they are in awe of how cozy it is. They exclaim over and over how much they love it. One patient left me a note saying that she had stopped by after being in physical therapy down the hall and simply rested and relaxed on my couch for a few minutes listening to the soothing music I had on the CD player.

I'm getting new patients like crazy. I had a patient who left her previous doctor because she had been called "non-compliant". I came to see how this happened when I sent for the records. The doctor had written, "call patient and check for non-compliance" on her lab results, and the nurse had apparently taken him literally. If he hadn't been seeing 35 patients a day, he would have had time, perhaps, to call the patient himself and not put the blaming message across. (I know this doc, and he is a total sweetheart). It turns out she was afraid of possible side effects of her meds, but had never been able to take the time to discuss her fears and get them in perspective.

It's MINE. I am responsible for the mail, the cleanliness, ordering supplies, the music, the scheduling, etc. Since it's very small, I can handle it, and there is joy in taking care of many of the small things. The way other women perhaps are "house proud" or men like keeping a neat yard, I get satisfaction from watering the plants, ordering purple top tubes, and maybe most of all opening the checks and stamping "FOR DEPOSIT ONLY" on them! ;-)

Ok I hope I haven't bored you all to death. I guess I'm past the initial scary time and into the honeymoon...sure is great, thank you Gordon, I would never have had the guts to do this without your inspiration!"

I feel the same way about Gordon. Gordon is Dr. Gordon Moore, who started this concept of a low overhead, solo practice as a means of improving the practice model to the benefit of both patients and physicians.

I am reminded of a book I read in college, Small is Beautiful by E.F. Schumacher, and am surprised at how much the concepts of this book are reflected in the "Solo-Solo" doctor model:
Schumacher maintains that man's current pursuit of profit and progress, which promotes giant organizations and increased specialization, has in fact resulted in gross economic inefficiency, environmental pollution, and inhumane working conditions.

Sounds a lot like our current American health care system to me.
Schumacher challenges the doctrine of economic, technological, and scientific specialization and proposes a system for Intermediate Technology, based on smaller working units, co-operative ownership, and regional workplaces using local labor and resources. With the emphasis on the person not the product, Small is Beautiful points the way to a world in which Capital serves People instead of People serving Capital.

"Emphasis on the person" is right. This is what being a doctor is all about. That and marketing.