Wednesday, February 15, 2006

Happy Anniversary!

Two years ago today I left my secure but overworked job as a staff physician in a managed care organization and opened a solo family medicine office ala the Gordon Moore hi-tech, low overhead model.

As I've pointed out before, my practice is atypical of most solo practices (even for a Gordon Moore-type practice) so this should not dissuade anyone who might be thinking of going solo. Most of the solo physicians that I know of who are trying this model generate a higher income than me. I am fortunate to have a spouse (Hi, honey!) who has a well-paying job so that I have the luxury of being able to grow my practice slowly. So that being said, here are my current statistics (last year's numbers in parentheses):
Unique patients seen since practice opened: 523 (201)
Patient visits: 1194 (357)
Average # visits per week: 18.1 (14)
M:F ratio: 49.5% male, 50.5% female
Average age: 37.7 years old
Oldest patient: 97 years old
Youngest patient: 2 months old
Sources of patients: Word of mouth 32%; Relatives of current patients 22%; Insurance provider list 19%; Paid advertisements 7%.
Payor mix: PPO insurance 81%, Cash 15%, Medicare 4%, HMO 0%
Average charge per visit: $133.73 ($114.27)
Average payment per visit: $74.31 ($70.06)
Total charges: $112,400 ($40,785)
Total collections: $54,976 ($17,515)

Bottom line, my practice continues to grow slowly but steadily. I have a fairly young patient panel which explains why I've only had to admit 5 patients in the past 2 years. This means very few phone calls in the middle of the night, but I still need 3 more hospitalizations to upgrade my hospital staff privileges from provisional to active. I'm pretty sure I made a profit this past year, but not a big one. This year should be even better. Everyone has said it takes 2-3 years for a new practice to become profitable, so I seem to be on pace.

Medical practices have a life cycle, too. As another solo doctor has observed, "I do remember this major all-consuming time of figuring out how to open the practice, followed by the major all-consuming job of figuring out how to bill, make appointments, get efficient, feed the family, survive. Now, it's just figuring out how to keep up efficiently with the health needs of over 1000 people." I am at the "get efficient" stage.

Time to get to work.

Sunday, February 12, 2006

I'm Back

I haven't posted in a while, but I am still here, plugging away in my solo one-doctor Gordon Moore-type practice. Not much has changed since I last posted. I am still seeing about 20 patients/week, although it dropped a little when I temporarily closed my practice to new patients in November and December. I did that in order to catch up with my medical billing, although I seem to have fallen behind again. I have come to the realization that I am not disciplined enough to "do all of today's work today" and am seriously considering getting someone to help me with some of the billing/administrative work. But that's something that will come later.

In the meantime, I hosted another 3rd year medical student (this time from USC) for a 5 week family medicine rotation which just ended last week. Although we didn't have a whole lot of patients (which I feel bad about), hopefully we made up for it with quality over quantity. As with other students who have rotated with me, I asked her to write down some of her impressions in working in this type of medical practice. This time, in response to a previous comment by Dr. Mathew Wang, I made sure that I completed my student evaluation BEFORE receiving her write-up so that it would be as unbiased as possible.
"A completely different type of practice! When I first called Dr. Seto to set up my family medicine rotation, he was hesitant, saying he wasn't sure if I would want to come to his office. He went on to describe that he ran a solo practice, no staff. He said he also usually only saw about 4 patients per day, never more than 8, and sometimes made housecalls. This sounded interesting to me, so I signed up. It was great. The level of patient care he could provide was second to none I have ever seen. The open access model was incredibly appealing. His patients were very satisfied. I thought it was great that a patient could call with a complaint, and Dr. Seto would say, "Can you come in right now?" Amazing. The amount of time spent with the patients was about four times that in most offices I've seen. This was both great for the patient, and great for me. As a medical student I appreciated being able to work through the problems and not rush, and being able to observe Dr. Seto give a truly comprehensive evaluation to the patients. I imagine an outing to the doctor for most people is a one to two hour trip or more. The difference with Dr. Seto is the one to two hours is all with him, not in a waiting room. I felt lucky to be able to get a glimpse of this type of practice is run. Yes, there was downtime, but I always had reading to do. This was when Dr. Seto would do some of his administrative work. I hope to see more practices like this one in the future."

Mariah Baughn

Thanks for your comments, Mariah, and for graciously allowing me to post your name.

I hope to see more practices like this in the future, too. That is why this blog exists. Because I believe the practice of medicine can be much better than the way it is being delivered to the majority of Americans right now. I don't know if this is the best way but I think my patients are happy, as am I. How many patients and doctors can say that? I think it's interesting that whenever I run into someone I used to know at my old job, they often ask me, "Are you happy?" to which I always answer a truthful "Yes". So this venture is a work in progress, a story that is still being written. Hopefully, one with a happy ending. Okay, I'm ready to start the next chapter.