From:
"Stacy Smith" <ssmith6@twmi.rr.com>
To: <Gmoore@IdealHealthNetwork.com>
Subject: practice questions
Date: Wed, 12 Apr 2006 10:41:15 +0800
Organization: Stacy Smith
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Dear Dr. Moore,
I have
really enjoyed reading about your idealized medical practice over the
years. I first learned about you in a Family Practice Management article
in 2002. At that time I was in a large group and contemplating making a change.
Your article really inspired me and I did go into private solo practice, but
unfortunately made some huge mistakes along the way. First, instead of
going "totally solo" as you described in your article, I hired one
front office / assistant (someone from my previous office who I knew was quite
capable). I knew her salary and benefits would be a lot of overhead but I
theorized that if I saw 15 patients a day I could cover it and make a decent
salary. This seemed like it would be a breeze as I was coming from a
practice where I saw about 25 patients a day. The problem came when I
just did not build up to the 15 patients. This was due to a number of
reasons, including a less-than-optimal location, losing many of my previous
patients due to the fact that I did not want to take certain HMOs,
and others reasons including the horrible
Meanwhile, I have pretty much exhausted my savings and have reached a breaking point. I have 1 and a half years left on my office lease (for a space that was too large and expensive to begin with - another mistake!). I am now in a position where I just cannot afford this assistant, who by the way, has done an outstanding job for me. I am looking at going into the "totally solo" mode. I have always been concerned I wouldn't be able to "handle" being totally solo, but then, I had a pretty good test run when my assistant went down with a gallbladder attack a few weeks ago and I was on my own for a week and half. I was a little nervous, for sure, especially since this was a totally unplanned event. Well to my surprise, things actually went quite smoothly and I proved to myself that I can do it. Of course, I want to go into this WANTING to do this, not just because I feel I have no choice. But, to be honest, this is what I think I was interested in from the very beginning; I just didn't have the guts to do it all the way.
It's so ironic to say I didn't have the guts to do it, because if I did, no matter what, I almost certainly would not be in such dire financial straits today. I am pretty sure I will go ahead and go "totally solo" in the Fall but I do have some concerns that I'm hoping you can help me with. First, as difficult as it will be for me to let my assistant go, I will have to do it. My patients will really miss her and I'm concerned about what my patients will think about my new practice model. Will they think I'm a mean-spirited person for letting her go? Will they think I'm greedy and just want to make more money by not having to pay her salary? It's an awkward situation for me because basically, I'm admitting I wasn't successful enough to support her salary and that's a difficult thing for anyone to admit. Of course, the patients really don't have any idea of the tremendous expenses related to a medical practice. Any ideas you have on explaining this delicate situation to patients would be appreciated.
Another problem for me is deciding whether to close my practice - at least initially in the Fall. This is difficult for me to decide, because the number of patients I see per day varies quite a bit, though the average is 11-12, which is my goal for being in solo mode. For example, yesterday I saw 17 patients and today I saw 9. Usually, each day I will have around 4-5 scheduled appointments and the rest are same day calls. The number of same day calls seems to vary quite a bit and therein lies the problem. I never know if I'm going to have to try to accomodate 12 same day call-ins or 3-4. Maybe this is a sign that I should close my practice. I think I could handle that rare 17 patient day if I schedule strategically. I already try to use a half hour per patient and I do understand the benefit of open access scheduling, but I wonder: how do your patients schedule Physicals and Paps? It seems to me, patients would have a problem with scheduling an appt. like that on a same day basis. I would appreciate hearing your thoughts on this.
There are a lot of logistic things for me to work out but I am a pretty creative and organized person, so I think I will indeed work them out. In a way, I think I am beginning to relish the challenge of it all. Of course, I am a little shell-shocked after some of my previous business mistakes, but I think sometimes all one can do is try hard to learn from one's mistakes and move on. I think I have to keep my eye on the goal of just providing excellent medical care and keep things as simple as possible. Thank you again for providing a model for a lot of us family practitioners to follow. I would really appreciate any words of advice you can give me.
Thank you in advance,
Stacy L. Smith, MD
(248)615-0050