I've gotten a number of calls from doctors who read the article about me and my solo practice in American Medical News, some to ask me questions about how I'm doing things (and how I'm doing, financially). A few have called to say that they've already been there, done that, and offered encouragement to hang in there. It makes me wonder how many other doctors are out there already doing what I'm doing, but who haven't been publicized. Quite a few, I think.
One particular local general internist has gone out of his way to help me. He went solo 7 years ago and now has a booming practice. He has been closed to new patients for the last few years. He read about me in AMN, then called me to see if I wanted to meet for lunch. I visited his office, and he gave me a copy of his original business plan (which was better than mine but similar in many ways), and gave me pointers on how he started his practice.
After residency, he had been working for a group of older internists and he was very busy, and getting busier. The older partners weren't that interested in working as hard, so the younger doctors saw a lot of patients. Since they were thinking of retiring, they offered to sell the practice to him and the younger doctors for more than he was willing to pay. They ended up lowering his pay, so he decided to quit and set up his own solo practice. However, he decided not to sign up with any HMO contracts, which at the time was considered very radical. He was called crazy by his colleagues and written up in newspaper articles and interviewed on national news networks.
(Arizona Republic; 03/21/99)
Now is the winter of doctors' discontent. Across the United States, doctors are complaining that the era of managed health care has robbed them of autonomy, income, time, prestige - even self- respect.
"This is life in hell," says Rex Greene, a Pasadena, Calif., oncologist and president of the Los Angeles County Medical Association - and he says he's an optimist.
A growing minority is rebelling - dropping health-maintenance- organization contracts, seeking clout in professional alliances or unions, filing lawsuits, retiring early, going out on disability or moving out of markets colonized by managed care.
Consider the San Diego gastroenterologist who slapped his physician group with a lawsuit after he was fired for spending too much time or money on patients. Or the cardiothoracic surgeon from the same city who moved to South Dakota, where managed care is nearly non-existent. Or the Pasadena internist whose frustration forced him to cut all ties to HMOs.
"I have been unneutered, restored to my vigorous self," said internist Andre Ettinger. "I can take care of patients rather than having to punt the ball all the time."
Times have changed. Managed care is no longer the main game in town. I have personally chosen not to sign up with any HMO or capitated plans, and this is no longer fodder for national news.
Hopefully, like this doctor, I will succeed without any HMO contracts. The key to his success, he feels, was in introducing himself to other doctors on the hospital staff. In other words, networking. He would have lunch in the doctor's dining room, and chat with the doctors who were there, and later that afternoon get a call from a patient who was referred by one of the doctors he had lunch with. Eventually, he had more than enough patients and he was on the road to a successful practice. Perhaps too successful as he now finds himself staying late, squeezing in extra patients, etc.
He said he is grateful to the many doctors who helped him get started, with no gain for themselves, simply because they wanted to help him out. Now he wants to "repay" their kindness by helping new doctors like myself out, and I'm very grateful for his help.
I hadn't really considered other doctors as a major source of patients. I figured other primary care doctors might see me as a competitor. And I thought specialists only received referrals FROM other doctors, not made referrals TO other doctors. But there appears to be a collegiality among all the doctors I've met so far. Since this doctor's practice is closed to new patients, he said he is actually glad to know of another doctor he can refer new patients to. And apparently, lots of specialists see patients who are looking for a primary care doctor and hope for a recommendation from their trusted doctor.
So this week, he introduced me to a dermatologist. Next week we're meeting an Ob-Gyn and an orthopedic group.
Apart from his contacts, I'm finding out how important networking is. I just mailed a practice brochure and business cards to another Ob-Gyn who contacted me after reading about me in AMN and, feeling a kinship because of our mutual solo status, requested some business cards. And a gastroenterologist I referred a patient to also asked for some business cards. At this rate, I'm going to need to order more business cards. I hope this translates into new patients, but it certainly can't do any worse than my ad in the local church bulletin: $400 annually for a weekly ad = 2 patients (so far).