From: "brownbears74" <pfhcks@sbcglobal

From: "brownbears74" <pfhcks@sbcglobal.net>
Sender: Practiceimprovement1@yahoogroups.com
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Fri, 21 Apr 2006 13:10:34 -0000
Subject: [Practiceimprovement1] The plight of Dr. S
Reply-To: Practiceimprovement1@yahoogroups.com

Good responses thus far to this problem. Dr. S is not alone--I
think if several past posts are read--many here have struggled
financially. Those in traditional practices struggle too. In fact,
the longer I do this, I find that many hospital owned primary care
practices probably lose money and are "subsidized" by more
profitable (or charitable) arms.

I wouldn't be too sure downsizing is the answer. One of the biggest
lessons I have learned from a small practice is that the doctor
needs to be seeing patients, not spending hours scanning charts,
pouring over EOB's, cleaning the office--I don't know how long S has
been in this, but you won't want to do this day in and day out
forever.

I still try to review every EOB that comes in, but utilize a part-
time asst to post payments, send statements, scan documents that
come in on patients. Not only does this save me time and burnout--
but she also quickly pursues balances (before my asst, I would have
ebb and flow billing-maybe once/month would catch up on things). I
have really come to question the viability of how anyone can do this
truly solo--I know some do it and these are probably the most
efficient and streamlined practitioners, but economically, it
doesn't make as much sense.

One major problem in ideal or traditional primary care medicine, is
that one doesn't know what's going to happen day to day, busy or
slow. Yet, unfortunately, the doctor is required to be there day
in, day out, whether you're twiddling your thumbs or going at a
frantic pace. It's the "24 hour" convenience factor--people pay
dearly for this in an ER, yet Primary care providers subsidize the
cost of this through staffing and personal/family time sacrifice.

One potential solution, yet unfortunate, is to cut back both the
staffing and your own hours. If you can't generate to staff 5
days/week, cut back to 3 days/week, allow both yourself and your
staff to find alternate part time positions. Have your asst go to
half-time--may not work for them, but hey, it's not working for you
now.

My personal practice--I struggle with my practice time vs outside
opportunities in the form of locum tenens. I have found that with
the shortage of primary care, there is no shortage of primary care
locum tenens opportunities (mostly rural, but I bet there are some
overworked metropolitan PCP's that wouldn't mind some respite). My
locum tenens opportunities have grown so much this year, I'm
struggling to not neglect my micropractice (which provides me the
most satisfaction of course) and my home time. But, the point is,
the work is there. It's no fun to live month to month financially,
and I'm willing to compromise that I'm not sure I can be on call
24/7 for my patients and make it financially or personally. This is
a personal bar that is set differently for each individual.

There is a breaking point in that, yes, you can and will build
enough patients (remind Dr. S that practices can grow exponentially)
to make income goals, but you also exponentially increase your
outside phone calls, demands on your time, paperwork, and non-
reimbursed work (phone calls, emails, "please sign this
disability/family leave paperwork for me in triplicate").

I haven't taken new patients (except family members of established
patients) for 6 months. I have decided to do what I can for who I
have (about 80-85% of my working hours), and find a financial
supplement through locum tenens (about 15-20% of my working hours,
but about 45% of the income).

Hope this helps someone.

Chris