Wednesday, August 31, 2005


I was visited by Dr. Linda Lee and her husband, Ben, yesterday morning. She is another family physician practicing in the solo-solo Gordon Moore mode, and she also happens to be Gordon Moore's next door office neighbor in Rochester, NY. She was in town visiting relatives (and getting some surfing in!).

It was fun to share experiences and compare notes. She has a practice that seems very similar to mine. She has about 500 patients, and works about 3-4 days/week while her 3 kids are in school. She is very flexible with her scheduling. She has a working spouse so they are not solely dependent on her income. She has closed her practice (sort of) to new patients, accepting only relatives of already enrolled patients. She has no employees and does everything herself, although Alteer makes it very easy for her to bill electronically, while I have to use a separate program that doesn't share info with my EMR. On the other hand, I didn't pay $20,000+ for my EMR, so I'm not so worried if my EMR company goes bankrupt and takes my data with it.

We first "met" online though the e-mail listserve started by Gordon Moore as a resource for physicians wanting to go solo like him. The online community that has gathered around this listserve has been invaluable to me and many other physicians who have gone solo or are contemplating it. It has been a wonder to see discussions by physicians from all four corners of country (Washington, Florida, Maine, California) as well as many states inbetween. We even have a member who is serving in Afghanistan!

We are like a start-up lab for solo doctors. It is very gratifying whenever another doctor posts an announcement saying that they are going live, like this doctor in Canandaigua, NY did just today:
Here we go! In another five hours, my malpractice insurance engages, my new provider numbers and tax ID kick in, and I have my first two patients scheduled tomorrow morning and about 22 other new patient visits scheduled for the month. My 150 square foot office is stocked (mostly)and the rent is paid. I can't thank the group enough for the outstanding support and advice.

I remember the excitement and dread of starting up. My practice has come a long way since then, yet I feel that I still have a long way to go. The destination is not as important to me as the journey itself. I continue to fine tune my practice to try to become more efficient and provide optimal care, as well as more financially stable.

On August 23rd, I saw my 400th patient. Just last week I changed the announcement on my answering machine to say that I am not currently accepting new patients. This is a temporary closure to give myself time to catch up on my billing, which I still do myself. Actually, it's more of a filter than a closure since I still accept family members. I've added 7 new patients since I "closed" to new patients.

After the article about physician blogs came out, I added a paragraph in my Notice of Privacy Practices:
F. Weblog Notice:
The doctor maintains an online weblog that sometimes describes information about his practice and interactions with patients. At no time is any protected health information (PHI) given out. No patient identifiable information is ever given out and details are changed to protect patient privacy. The weblog is located on the internet at:

So far no one has said anything about it, but that's probably because, instead of giving everyone a separate copy like I used to do, I laminated the Notice of Privacy Practices and put it on the clipboard with all the other registration forms. Probably no one has even read it. I know I wouldn't. Plus it saves on paper. I'm still working on trying to shorten my registration and intake forms to save even more paper.

About two month ago, I started asking/requiring all new patients to sign a Binding Arbitration agreement that was provided by my malpractice carrier. I think they suggest it to all their policyholders, as I have not been sued. Arbitration bypasses malpractice court in the event of any medical dispute, which I think most people would agree is a good thing. Instead (and this is how I explain it to patients), "You get a lawyer, I get a lawyer, we agree on a 3rd neutral party and then we arbitrate." Faster, quicker, easier, fairer. I hope I never have to use it.

I reason that if I ever did get sued, I would have to shut down my practice temporarily since there is no one else available to keep it running. I feel secure enough now with the number of patients I have that I wouldn't mind if I lost a patient or two because they refused to agree to arbitration. Plus I think it may be more common in California for medical practices to require arbitration. I know Kaiser requires all of its members to accept arbitration.

So far, only one person has refused to sign it (the first person I ever gave it to), and I went ahead and saw her anyways. But now, I would tell them that I would not be willing to accept them into my practice without it. As my established patients come back for repeat visits, I am asking them to sign the arbitration agreements, too, and everyone has agreed so far. In fact, most people have been very supportive and express sympathy for the plight of doctors having to deal with malpractice.

I am also very happy with my new high-speed Fujitsu Scansnap fi-5110EOX scanner and wish I had gotten it sooner. The only drawback has been that they haven't officially released a Mac driver for the US Market, so I had to download one from the company's Japanese website. It works perfectly, but it does look a little strange to see a Japanese dialog box pop up every time I scan something.

More tweaking to come...