Wednesday, August 18, 2004

Staying the Course

Last week was a pretty good week for my still fledgling practice: 9 office visits, 5 new patients who all had physicals. This week: 6 office visits, 5 more new patients. Six months into my solo practice, I've had 73 office visits with 60 unique patients, with an even 50-50 split between the sexes, 30 males, 30 females. The average age is 36, and I'm definitely seeing more children and teenagers than in my former practice at Kaiser. This means most of the patients tend to be healthy, which makes for easier and more enjoyable visits, too.

Compared to some of the other doctors who are trying the "low overhead" or "Gordon Moore" model of practice, I feel like an old tortoise racing against Olympic-caliber hares. Scott in Florida just opened a practice right out of residency and saw 45 patients in his first two weeks. Michelle in Colorado closed her practice to new patients after less than a year, capping her patient panel at 450 patients.

Getting approval for insurance participation should help my practice grow. I learned just last week that I have been approved as a participating provider in Blue Cross of California, which has been the most common insurance my patients have had: 36%. That makes two health plans I have joined, Blue Cross and Cigna. I called Blue Shield the other day to ask what the status of my application was and found out that somehow my application had "slipped through the cracks". My credentialing had been approved back in April, but my application was never sent to the appropriate department to finalize participation. Whoops.

Yesterday I received an approval letter from Medicare, which was very fast, compared to the others. Looking back, it took about 6 weeks from the time I mailed the application to the time I got the approval letter. The third party insurers took about 3 months (with some still counting.... )


Even as my practice seems to slowly pick up steam, I recently got an offer to buy an existing practice in a neighboring city. It is a successful practice with about 1500-2000 active patients, and the doctor is able to make a good income despite having two part-time employees and seeing about 42 patients on the 4 days of the week he works. When I heard these numbers, my first reaction was, "How can he do that?" But in analyzing the numbers a little, it does seem credible. I think I'm still not used to seeing a lot of income because I have not been keeping up with the billing.

When I first considered going into private practice, it had occurred to me that buying an existing practice would be one way to become financially solvent faster. But at the time, no one was advertising a practice for sale, and I wasn't about to go from doctor to doctor asking them if any of them were thinking of retiring. But buying someone else's practice means you get a lot of things that you don't want, too. There would be his employees, who are probably very nice, but a new kind of responsibility to deal with. There would be all the paper charts, since he is not using electronic medical records. His patients might be used to a different style or philosophy of medicine. But I would probably be instantly busy, seeing 10-15 patients/day compared to the 3-9 patients/week that my practice currently enjoys.

It would also mean either:
1) moving my location to another city, which would force me to give up my goal of being my home town's one and only family doctor.
2) Or moving the other practice to my current location (and risk losing patients from that practice)
3) Or keeping both locations and shuttling between them.

I would not be able to keep as tight control over everything, since I'd be forced to delegate appointment scheduling, billing, keeping track of supplies, etc. Some of this would be desirable. It'd be nice to have someone else answer the phone when I'm busy with a patient, rather than a recorded message. And billing can be tedious, when you have a lot of bills to process or if you have to call the health plans to argue over a denied claim.

So today I thanked the other doctor for the generous offer, but I preferred to stay the course and continue building up my own practice. I hope I don't regret it.


I recently read a newspaper article about another doctor in San Diego who has been practicing completely solo, but he seems to have come up with the idea independently of Gordon Moore. Great minds think alike, eh?

And what can I expect for the future? Hopefully a little of what Kelly is getting. Kelly in North Carolina opened her solo practice about a year ago, and recently provided an update to the members of the Practice Improvement listserv. She wrote:

"My practice is incredible...I knew how hard this would be, but there are so many things that come up which I could't have even imagined let alone plan for.  I finally had to hire someone to help with billing...actually allocating payments and keeping up with the insurance companies, as Alteer handles the actual billing beautifully.

I'm still getting many calls a day for new patients, I have started accepting two a week and am scheduling them into January.  It feels stupid, as I hold my open access system dearly (for my established patients only).  But my waiting list was daunting and I don't want the responsibility of if the people aren't minding I guess I shouldn't.

Though the insurance companies were definately NOT worth the hastle from November until July, they definately ARE now.  The reimbursement has been excellent this month.  Now that I have my pattern established with the ten biggest companies here I'm not having to call much anymore.  What a relief, and I'm getting paid much better than if I charged cash.  I also like the variety of patient's that it allows.

Have to go pick up my kids, who are also very happy with the life this practice allows, and have dinner with my husband (also a doctor at a local clinic) who is getting very jealous of the time I get to spend with my patients."

This gives me hope for a financially viable practice. I already am enjoying the time I spend with my patients - a practically obscene 60-90 minutes with a new patient has been my norm. And it's certainly gratifying to get comments such as this from my patients: "Thank you for being someone who wants to bring the caring quality back into Doctoring!"


On a final note, I passed my Family Practice Boards (like 90+ percent of the doctors who took it). Yay. Now I have an excuse to send off a press release to the local paper and try and drum up some more business. I may be slow, but I'm not dumb.