Q: I am an internist in private solo practice in Mesa, Arizona. I am very interested in your practice model. I would like to be able to spend more time with patients, but my overhead mandates a higher volume of visits. Would you mind telling me how things are going for you and any suggestions you may have. For example, which EMR are you using? How do you cover patients while out of town? How did you find your space, and what kind of space are you in? Any online resources to which you would direct me?
A: Thanks for your e-mail. In answer to your questions, I got the idea for this practice model after reading an article about Dr. Gordon Moore, who sort of pioneered this concept of a low-overhead type of practice. You can read about him here:
Other physicians around the country have also tried to emulate his practice, and there is an e-mail listserve started by Dr. Moore which exchanges information between those who are actively practicing this way or who are just interested in learning more about it. There are at least 30 doctors around the country who are using some variation of this practice model. The website for the Practice Improvement Group is here. To subscribe to the listserve, just send a blank e-mail to "Practiceimprovement1-subscribe@yahoogroups.com".
I have been in practice a little over one year, and business is relatively slow but steadily growing. I am currently seeing an average of 13-15 patients per week, which is actually my break-even point. My goal is to see no more than 12 patients a day (30 minutes appointments) 5 days a week. I use open access scheduling so people can almost always get an appointment the same day they call, unless they prefer a later date. It is very gratifying to be able to spend a lot of time with patients and get to know them. The biggest downside for me (besides the low income) has been the large amount of administrative work. I have no employees (to keep overhead low) so I chose to do everything myself, including medical billing, copying, filing, scanning, shredding. Of all these, the billing part has been the hardest for me to learn, but I am gradually getting better at it. It has been very educational seeing what it takes to get paid. But most of the doctors who are doing "low overhead" practices have at least one staff person to help them out, so their experiences are probably better than mine.
My EMR is a little-known program called SpringCharts. I chose it because:
1. It runs on my Mac. There aren't that many EMRs that run on Macs. Macs are easier to use, plus more secure than Windows-based PCs.
2. It is inexpensive. When I first got it, it cost $500. Now the newest version costs $895 for a single user version.
3. It allows me to store all my data locally. This enables me to keep my patient's data private and secure, plus I always have access to it even if the Internet is not available, unlike ASP programs which store the data at a remote location.
It is very nice to have all the medical history available a few mouse clicks away, and in my small office, there isn't much room for paper charts. Other EMRs that some of the other doctors on the listserve use are Amazing Charts (also cheap), eClinicalWorks, SOAPware, Alteer (very expensive), e-MDs, Praxis. No EMR program is perfect, but I would encourage everyone to at least start looking at what is out there. This article is a good place to start.
My office space is very small. A total of about 600 square feet, including waiting room and hallway that I share with a chiropractor and psychologist. I basically use one exam room (8 x 9.5 feet) and one 8 x 8 ft room that serves as my office. It is in a small 2 suite 1 story medical building that looks more like a house. It is about a block from my house. The rent is $1000/month.
As far as out of town coverage, I haven't gone out of town very much plus I don't have very many patients (261 unique patients to date) so that also reduces the number of calls I get. When I went to Banff, Canada for a week last summer, I recorded a message on my answering machine that explained that I would be out of town for a week but that they could still call me on my cellphone if they needed to speak to me. On my recorded message, I left the names and phone numbers of two local family physicians who agreed to cover for me if any of my patients needed an urgent visit (but no one called them). Otherwise, I'm always available by cellphone 24 hrs/day 7 days a week. I've only had two calls in the middle of the night so far. One from a patient with psychiatric problems who was having trouble coping with recurrent chest pains (I told her to call 911 and go to the emergency room) and another from the hospital ER informing me that I had an admission (whom I had expected to show up earlier that day).
It has not been easy to transition from Kaiser, where I worked before, to solo private practice. But I do get a lot of satisfaction knowing that I am in control (well, as much as anyone can say they are in control when they are dependent on third party insurers for payment) and can spend quality time with patients. And I am optimistic that my practice will continue to get busier and busier as more and more people find out about me.
I hope this information above helps you. And again, please subscribe to the listserve to get more information. Let me know if you have other questions. Good luck!
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