Re: from residency to micropractice?

[Guest guest]

>

I practiced 3 years in a larger group. It helped to learn more about patient

retention and to

become more comfortable with functioning independently. I don't think it is

mandatory.

House calls practice is difficult to grow and has a high replacement rate

(patients die fast). I

have maybe 12 homebound patients and see them every 1-2 months. Be aware that

many

home heath agencies are corrupt and be prepared to review each patient before

accepting

the case, many of them are not homebound and the agency just needs your

signature to bill

Medicare. Teen moms are usually on Medicaid, it's difficult to grow an ideal

micropractice

with Medicaid funds. Maybe you can find some sponsors and have a mix.

[Guest guest]

I'm not sure if time spent in an employed situation is a prerequisite for solo/micro. I spent 2 years in a Federally Qualified Health Center but left not having a clue about running a practice. Someone else did all the credentialling, billing, insurance "stuff" ordering supplies etc. and all I had to do was sign the papers that the practice manager put before me. It was only when I tried to change my info that I found that she had my birthdate wrong and it about took an act of congress to fix it. What it did give me was more comfort in the practice of medicine and I think it would have been harder to build my confidence in both patient care and running a business. I am still struggling with the later 7 months into my solo leap. The fact that you don't care about money is a huge plus as the student loans are my largest bills but not enough to keep me running on the "hamster wheel". Home visits are very rewarding, the elderly are very appriciative but

often difficult to get away from as the rarely get "company". While a resident I set up a rotation where I spent a few days in several private practices in an attempt to learn the business end. I actually met A at that time but she intimidated the sh@! out of me by "pimping" me with questions that I had never even thought of. I wish I had payed more attention but by then I had already taken an employed position. Melodylsaintlo wrote: Greetings friends,I am a second-year fam med resident interested in solo/micro. I noticemost folk here spent a lot of years in some kind of group practicebefore changing. Do you think this is necessary?Somebody observed that veterinarians don't do this - they typicallysolo or partner. Others have opined that it depends on the area inwhich you want to practice - in some spots, starting out solo could bedisastrous - I sure don't want a disaster.My primary yen is to take care of poor people, and I have a specialinterest in teen moms. But I love the older folk too. I'll have asolid grounding in obstetrics and midwifery when I'm done (I LOVE myresidency program) - with a minor in behavioral med (a specialty track- I'm actually dual maternity and psych). I'm more of a chronic thanan acute type of practitioner.Everything I've learned about large group and multispecialtypractices, with their

productivity requirements and no-competitionrules, sounds awful. I would probably be happiest doing housecalls -or seeing people in the parlor. I tend to take a long time withpatients. I give them my pager number and they don't abuse it (duh).My own kids are grown, and I actually can go pretty much anywhere Iwant when school's out. I live in Milwaukee. I'm most comfortable insmall cities. I'd prefer to send patients to hospitalists and/orteaching services (I like knowing inpatients are looked after bysomeone who's there all day/night). I'm computer and web savvy. Idon't care how much money I make - I don't even have cable.Suggestions? Best way to start from residency?Best way to prepare, during residency?Hospital privileges in brand new locations: hard, or easy?How do you find out how friendly an area is to family docs?How do you find out whether it would be disastrous to try to startmicro in a

particular place?Paying off those amazing student loans while micro or semi?Timing for starting a job hunt/ relocation hunt?Pitfalls? Mistakes?Thanks.Leigh Saint-Louis MDColumbia St. 's Family MedicineMilwaukee, WI

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[Guest guest]

Leigh,

Come to IMPCamp

this summer. You will be able to get all kinds of wonderful advice given by

warm compassionate docs who have all made the leap themselves. I will be in

Rochester, NY and will be the weekend of June 20th. It will be in Rochester, NY. Should

be loads of fun as you get to meet many of the characters whose posts you read

regularly. More information will be sent out as details are finalized. Stay

tuned.

Re: from residency to micropractice?

Leigh,

Congratulations on wanting to start a micropractice. As to your list

of questions:

- I started the year I graduated residency. I spent 3 months with

another doc first, and learned all the things I didn't want to be /

do from him. You could skip that part, just read the listserv for

education and be the person you want to be.

- Absolutely get educated on different major insurers in areas you

are thinking of re-locating to. Avoid heavily penetrated managed

care areas.

- Hospital privileges are very dependent on politics, more than

need. There is no reason you can't apply while still in residency.

One hospital I tried to get on staff, that seemed friendly, kept my

application in committee for 2 years! It turns out the head of the

committee thought I would be doing EMG's and be a competitor to his

practice (I don't even do EMG's and didn't apply for them).

- Call other docs in the area you are targeting, in multiple

specialties, ask you questions about the need in the area. Take a

lot of what they say with a grain of salt, they may see you as a

competitor if the market is tight. Then call as if you are a

patient trying to get a new patient appointment to the family docs in

the area and see how long the wait is! If there's not much wait,

then the area is over-supplied with docs.

- Call the medical directors of managed care organizations there and

flat out ask them if they need more family docs in your target area.

The good ones will tell you the truth (and they all have the

statistics). (I got that idea from talking to a guy who used to be a

med dir of an HMO).

- I had my student loans paid off entirely in my first five years of

micropractice, 15 years early, and paid off my house, too. You can

make it work, just like any other practice, if you plan well.

- Go to one of the meetings being organized by the listserv people

(In Rochester in June, Sharon is doing that one, I have one

planned for April in Florida, more basic intro one). Pick the brains

of everyone there.

- If you like geriatrics, and as you said, you want to visit people

in their homes, you are golden. There is tremendous opportunity

almost everywhere for good geriatricians. You don't need to

moonlight, you just need to locate near an area with a decent senior

population. Then do housecalls, nursing home and assisted living

visits. The good, friendly docs get deluged fast. that will sustain

you while you build up the rest of your practice.

- Start looking and planning now. It takes a long time to get your

license for some states (took me a year for Florida), and your

Medicare number.

Hope that helped.

>

> Greetings friends,

>

> I am a second-year fam med resident interested in solo/micro. I

notice

> most folk here spent a lot of years in some kind of group practice

> before changing. Do you think this is necessary?

>

> Somebody observed that veterinarians don't do this - they typically

> solo or partner. Others have opined that it depends on the area in

> which you want to practice - in some spots, starting out solo could

be

> disastrous - I sure don't want a disaster.

>

> My primary yen is to take care of poor people, and I have a special

> interest in teen moms. But I love the older folk too. I'll have a

> solid grounding in obstetrics and midwifery when I'm done (I LOVE my

> residency program) - with a minor in behavioral med (a specialty

track

> - I'm actually dual maternity and psych). I'm more of a chronic than

> an acute type of practitioner.

>

> Everything I've learned about large group and multispecialty

> practices, with their productivity requirements and no-competition

> rules, sounds awful. I would probably be happiest doing housecalls -

> or seeing people in the parlor. I tend to take a long time with

> patients. I give them my pager number and they don't abuse it (duh).

>

> My own kids are grown, and I actually can go pretty much anywhere I

> want when school's out. I live in Milwaukee. I'm most comfortable in

> small cities. I'd prefer to send patients to hospitalists and/or

> teaching services (I like knowing inpatients are looked after by

> someone who's there all day/night). I'm computer and web savvy. I

> don't care how much money I make - I don't even have cable.

>

> Suggestions?

>

> Best way to start from residency?

> Best way to prepare, during residency?

> Hospital privileges in brand new locations: hard, or easy?

> How do you find out how friendly an area is to family docs?

> How do you find out whether it would be disastrous to try to start

> micro in a particular place?

> Paying off those amazing student loans while micro or semi?

> Timing for starting a job hunt/ relocation hunt?

> Pitfalls? Mistakes?

>

> Thanks.

> Leigh Saint-Louis MD

> Columbia St. 's Family Medicine

> Milwaukee, WI

>

[Guest guest]

IMPCamp - is it really camping? i love to camp. i will stay tuned.

thanks for all the encouragement, everybody!

[Guest guest]

uh oh

i had better answer you before this goes too far

No no camping.

Well I mean you can if you want to.

It is a conference with only IMPs IMP wannabees ,new iMPs, old-ish IMPs

When I do the CME through AAFP it is officially called IdealMedical

Practices Second ANnual Summer conference.

I dunno. Gordon or may have tent space in their back yards but the

rest of us stay in hotels.

I don't know why it got called camp last year.

There WAS swimming... Oh there was a sing along too.NO campfires though.

HOpe to see you there!

Sharon is in charge and will keep the list serv updated.

Re: from residency to micropractice?

IMPCamp - is it really camping? i love to camp. i will stay tuned.

thanks for all the encouragement, everybody!