Thursday, July 14, 2005

The Village Doctor

John Brady, MD, is a family physician who opened his own solo practice in May, 2003 in Newport News, Virginia. He is one of many doctors around the United States who is using the "Gordon Moore" low-overhead practice model.

From a Hampton Roads Daily Press article written by Alison Freehling in Feb 2004 (and no longer accessible online):
Last year, Brady opened a solo practice called "The Village Doctor". His only employee is a nurse who also answers the phones. Instead of a modern building, he rents an old home along Warwick Boulevard.

By slashing his overhead costs, Brady said, he can see fewer patients a day, go out on house calls and still survive financially.

"For me, it has allowed the joy to come back into medicine," he said.
Before opening his Newport News practice, Brady spent four years at a large local practice. He said he was lucky to get five or 10 minutes per appointment and got to know just a small number of the practice's 25,000 patients.

In Hilton, Brady has 680 patients and plans for no more than 1,500. He schedules hour long visits with all new patients and blocks out 20 to 30 minutes for others, unless there's a simple complaint such as an ear infection. People get in to see him the same day they call.

The advantage isn't so much catching more problems, he said, but having time to talk about how to stay healthy down the road.

"I don't just deal with the immediate health concern that brought them in," Brady said. "When I'm not in quick mode, I get to counsel them about not smoking, about dieting and exercising."

Brady has made as many as three house calls a day, although it's usually no more than one. He tries to limit trips to people who live in or around Hilton Village.

Maria Brooks, mother of 7 year old Michael and 2 1/2 year old Ben, has taken full advantage of the service. Michael has chronic ear infections and getting to the doctor's office with two young kids isn't easy.

"To be able to call him at 7 a.m. or 4 p.m. and you know he'll be there, that's amazing," Brooks said. "He's looked in their ears and listened to their chests, and you don't have to sit in a roomful of sick people to wait for it."
Stories like Brady's are already becoming more common, said Dr. Gordon Moore, a New York-based physician who started a similar practice in 2001 and helps other doctors do the same. More than 100 doctors are part of his online discussion group.

"We help each other as we navigate these uncharted waters," he said. "The number grows each month."

In the Practice Improvement e-mail listserve, John Brady recently shared this update on his 2 year old practice for the benefit of other physicians:
As was stated on my business plan (posted months ago), I ended up about $120,000 in debt at my nadir in 3/04. Since then, the practice has been doing relatively well and I currently sit about $86,000 in the hole. (Much of the indebtedness was my salary which I kept at $100,000/year so I would not go personally bankrupt). My accountant states that this is wonderful growth for a business, but I still hate being in debt. I am currently seeing 12-15 patients a day (4.5 days/week) and strive to see 15-18/day.

Lessons learned:
1) Moonlight to cover salary for the first few months the practice is open.
2) Market everywhere you go (church, children's activities, luncheons, restaurants) and always keep business cards handy.
3) Tell people "if you like it here, tell a friend."
4) Be careful which insurance contracts you sign

Biggest headaches:
1) Insurances-I have come to loathe them. They serve no real purpose except to make money and they do this by creating loop after loop to jump through until we get tired of jumping, and then they blame us.
2) Isolation-I was always in big practices before making the leap and I do not do hospital, so my interaction with other doctors is minimal. This leads to some professional isolation. I fill the void with local medical society meetings, etc, but it's still not the same.
3) Juggling financial responsibilities at home and at work (hopefully will get much better as the loans get paid off and my salary increases).
4) Trying to determine when to cut off to new patients-we are currently seeing 1 new patient a day which I hope will fill the void of those leaving the practice through moves or death (not my fault), but the balancing act between being too busy and not being busy enough is more difficult than I thought it would be.

Biggest benefits:
1) Freedom to practice medicine like I want. No bean counters (except my wife), no administrators.
2) Unfaltering patient satisfaction/loyalty
3) Being a small business owner. I know it sounds goofy, but starting something from scratch, nurturing it, and watching it grow is quite satisfying and a sense of great pride.
4) Scheduling freedom-If I need time off, I take it. Since opening the practice, I have only missed one of my kids' performances/meetings/parties/etc and that was because I was in Richmond lecturing to doctors about the benefits of EMRs. I have also found time to train for and run a marathon, which would have been impossible in the previous office.
5) Being on the cutting edge of the future of medicine-computers, database research, evidence-based information at my fingertips. How cool is that?

Would I do it again? Without question.


How cool is that, indeed.