Wednesday, November 07, 2012


You must be the change you want to see in the world.  
-Mahatma Ghandi 

On this Election Night, I ponder the future of our nation, which I have little control over besides my one vote, and my solo practice, which I have much control over. Although it has been 2 years since I last posted an entry, I am still doing pretty much what I was doing 2 years ago with a few changes.

I still have a solo micropractice in the same small office in the same small town. It has been about 8 years since I opened my practice. I still see a small number of patients per day (0-12). I still take PPO insurance but not Medicare. For the past 4 years, I have been charging an extra Non-covered Medical Benefits Fee per family per calendar year. It started out at $120, and this past year I raised it to $150.

I resist the term "concierge practice" because most concierge practices that I know of charge about $150 per patient per month or $1800 per year. But I accept that I have a "retainer fee practice" or what I call a "mini-retainer fee practice", and that this small fee helps to pay for the non-covered benefits my practice provides such as same day appointments, 24/7 access to me by cellphone or e-mail, and an unhurried atmosphere.

This small fee, equivalent to $12.50 per month or less than what most families pay for cable TV, has helped my small practice survive, and gives me the freedom to take care of my patients in a slower, more thoughtful pace, as well as giving me the time to get to know my patients better.

There are other physicians out there who choose to practice this way (but maybe without the extra fee), such as Dr. Christopher Wenner in Cold Spring, MN.
As health reform sweeps more Minnesota doctors into large health care organizations, 40-year-old Christopher Wenner is happily swimming against the tide. Three years ago, he decided to try something so old that it's new again: a solo medical practice in his hometown of Cold Spring, Minn. 
He's part of a fledgling national movement that's using technology and an entrepreneurial spirit to try to recapture what some say has been lost in the march toward corporate medicine. 
Wenner, who used to work for a large medical group, said he grew frustrated with the pressure to see so many patients per hour -- what's known as "throughput." 
"A typical day would be, oh, 25 patients," he said, for an average visit of 10 to 15 minutes. "It was just the most uncomfortable situation when I had five minutes with a patient and they had a big list of questions," he said. "It was never enough." 
Getting started was harder than he expected. "I had lean years," said Wenner, who has three kids. He took no salary for months, and moonlighted at a jail and urgent-care centers to bring in money. 
On the upside, he was free to make decisions without a committee. He can cover his costs seeing just two patients a day, he said; the rest is profit. A full day is 10 patients; the average visit half an hour. But if he wants to spend two hours with one patient, or make house calls, he can.
The "fledgling national movement" is the Ideal Medical Practice movement, which was founded by Dr. Gordon Moore. It has grown into a grassroots organization with members from all over the country, and has spawned over a hundred small practices from Maine to Oregon. It is this group that has provided me with tons of support and advice to help me keep my small IMP chugging along, like The Little Engine That Could.

I can't change the world. At least not by myself. But I have help.

If you are a physician trying to get off the hamster wheel model of modern medicine, as I once was, this group can help you, too.
Never doubt that a small group of committed people can change the world. Indeed, it is the only thing that ever has.
 -Margaret Mead