Lous words of wisdom; some of mine as a solo

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RE Lou--

Must have been a good dinner, no postings!!

Ok, I'll have a go at this as:

1) Been in practice since 1988

2) Worked an HMO staff gig until it dissolved, was doing that for 6 years.

3) Worked a hospital owned gig for 8 years, replaced by another who lasted for 4 years, he was replaced by 2 one of which lasted for 2 years and replaced by lower functioning doc, but one of the 2 lasted.

I went solo in 2004, took a long time, but am happy.

Secrets?

1) If you want to be the boss, you have to take risks, financial, political too.

2) Decide if you can afford 2-4 years of little to NO income vs doing the IMP as a side job in an area that needs good primary care/specialty care. Look for side moonlighting too, it can help your visibility.

3) Realize that if someone else pays you, they don't really/or always want your opinion. If YOU pay you, then you have the right to call the shots.

I have a small solo, about 50 pts per week, 2 FTE staff, outsource billing (my choice), EMR lower cost moving to ASP version for a monthly fee so I don't have to run a server. I was known in town so gradually have gotten up to speed.

Have 1 day equivalent out of office in salaried positions for hourly rate. Enough phone traffice in office that I decided to keep 1 now 2 FTE answering phones to keep all happy. For me, this made sense. For many others, cost prohibitive.

Lou comes from a big system place, fortunate enough to have some autonomy, I think I know what he's going to say but I'll let him say it.

Don't expect bank to come up with the money without collateral. If you want investors, sell control/stock. Think like a banker and they'll lend you money. It's still rather cheap as long as they know they can get their capital back and interest on the money is low and tax deductable.

I agree with many to keep rental costs to a minimum. I approached 2 specialists and work out of 1 extra room in a satellite and see 1/2 of my pts there.

You may have to go where the pts are, where they know you. Word of mouth is the most effective.

If you are committed to self pay model, you'll need to be sure that there's either a shortage of docs/"providers" in area, or people know you well. If you take insurance, don't take Medicaid except as charity clinic (which is fine, but in Pa, Medicaid pays $23/visit if they show, you'll never make it on that...).

So the down and dirty is that you'll starve for awhile. I'd rather starve and be happy than see pts I don't know. But I like chronic care, I have a small family, and it took me 7 years to crack 6 figures again.

Also I've done the other way (employed) and finally realized that the powers that be WANT you to work in the "big box" and cannot understand why you don't want to so...

Matt's laws of medical political survival:

1) If you work for a big organization with lots of turn over, they want your work but not your opinion.

2) If you don't sign the payroll check for support staff they don't work for you.

3) If you have to tell the boss something twice, STOP! They KNOW but can't do any different except you'll make them "shoot the messenger" and that's you.

4) Any medical office that treats the staff WORSE than they treat the pts will NEVER survive.

5) Low paying insurance will get you lots of pts, but you won't be able to pay your own bills. If you want to work at a clinic for hourly, you can find a job but it might be far away.

6) NEVER rent more space than you can really use. At best, share with a specialist if you're a primary, a primary if you're a specialist.

7) Some places don't deserve you (or won't pay you), you may have to leave and start over.

8) Any hospital system that complains that they're "loosing money on primary care" is LYING!!! They ALL loose money on primary care (MGMA stats say ave annual income of employed FP is about $!50K, but EVERY system has to pay out $0K of that; don't worry, hospital makes about $250-750K on your referral work and THEY KNOW IT).

9) Sorry folks but ACOs are like HMOs; if you save them money you'll never see it.

10) I like solo. I refer my pts to another doc who does 1/2 time hospital. I also don't share call, and enjoy following my own pts. Yes I take insurance. Yes I do same day/next day appts (aka Open Access Scheduling, see Murray/Tantua on the web) and get very few calls on nights and weekends.

Sorry Lou, I couldn't help myself.

Words from the trenches...of western PA.

Matt

Solo since 2004

FP since 1988

SOAPware since 1997, every pt since 2004

Appointmentquest.com for appts but pts don't make their own (for 4 years I think now)

Relayhealth.com for secure email communication, only 20% of pts will use it.

Outsource billing for 8% collections.

I support good software, but software doesn't support me

Regards to all esp those employed who can't get their work done. Remember the pts appreciate you, even if you're on the hamster wheel. Many have been there and we're trying to help you get off of it.

Re: Don't jump. Take the right steps at the right time for you.

So I hope I can say a few things that will help-it looks like I started a conversation going here. I had a funny thought that if I did not post anything else it would be like starting a bar fight and walking out the back door.I will post a few more things tonight, but first it's almost dinner and I need to get a beer.