Re: In an IDEAL world . . .

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Depends on the point in your medical career and personal life. Financial impediments for me. Being the sole income for myself, my wife, 2 children and one on the way with all the usual costs such as mortgage, insurance, etc. etc., it's not very tempting to leave employment where I gross over 150,000/year with typical MD benefits to open an IMP. I'm determined to try because of my sanity and the lifestyle choices for my family. I plan a 1-2 year transition. I don't want to turn any younger MDs off to solo practice, but it's just in the past year or 2 (I finished residency in 1994), that I've become consciously competent in my practice of family medicine - knock on wood. I see advantages in opening an IMP just out as residency as you are used to living on a small income, and your practice will grow financially as your financial burdens increase; but i question the competence, not the medical knowledge, of any family physician to practice solo right out of residency. Don't mean to insult anyone as I know some of you started IMPs right out of residency; I just believe that colleagues are important right out of residency to introduce one to the "real" world of medical practice. StrazThe answer is selection "a".LL <jantonuccifchn (DOT) org> wrote:1. B2. yes,maybe some In an IDEAL world . . .What do you all think is the biggest impediment to widespreadadoption of the ideal practice model in primary care?(out of these two options)A) Psychological Impediments (Fear of running a business, lack of skill,lack of IMP mentors, lack of awareness that IMPs exist, med studentsdumbed down/brainwashed to do things "the same way as we've alwaysdone things," conformist attitudes of docs, disorganization, sadistic love of suffering, enjoy assembly-line medicine, etc . . .) Financial impediments (high student loan debt, out of controlhospital dues/malpractice, low reimbursement, etc. . .)I know you may have other ideas here, but if you HAD to choosebetween these two what would y'all say?Second question is WHAT IF there was a fund to help primary caredocs start IMP practices. Write an essay, apply for the scholarship, get5-10K for start-up costs and some IMP training? Do you reallythink this would help at all????I tend to think the impediments are primarily psychological, but quite interested in the listserv take on this. And THANKS so muchfor the hospital dues input. I'm in the contemplative stage and getting ready to meet with the hospital bigwigs. I'll closewith some good one liners on the high hospital dues:"You mean you have to pay an admission fee to takeyour admission?""I find the 233% increase inhospitable & discourteousto courtesy staff physicians"We'll see where any of this gets me.Thanks again!PamelaNever miss a thing. Make Yahoo your homepage.

[Guest guest]

Straz-that is because you have already passed through the "'A" and now are onto the ''B".LynnTo: From: straz13@...Date: Thu, 24 Jan 2008 10:59:01 -0500Subject: Re: In an IDEAL world . . .

Depends on the point in your medical career and personal life. Financial impediments for me. Being the sole income for myself, my wife, 2 children and one on the way with all the usual costs such as mortgage, insurance, etc. etc., it's not very tempting to leave employment where I gross over 150,000/year with typical MD benefits to open an IMP. I'm determined to try because of my sanity and the lifestyle choices for my family. I plan a 1-2 year transition. I don't want to turn any younger MDs off to solo practice, but it's just in the past year or 2 (I finished residency in 1994), that I've become consciously competent in my practice of family medicine - knock on wood. I see advantages in opening an IMP just out as residency as you are used to living on a small income, and your practice will grow financially as your financial burdens increase; but i question the competence, not the medical knowledge, of any family physician to practice solo right out of residency. Don't mean to insult anyone as I know some of you started IMPs right out of residency; I just believe that colleagues are important right out of residency to introduce one to the "real" world of medical practice. StrazThe answer is selection "a".LL <jantonuccifchn (DOT) org> wrote:1. B2. yes,maybe some In an IDEAL world . . .What do you all think is the biggest impediment to widespreadadoption of the ideal practice model in primary care?(out of these two options)A) Psychological Impediments (Fear of running a business, lack of skill,lack of IMP mentors, lack of awareness that IMPs exist, med studentsdumbed down/brainwashed to do things "the same way as we've alwaysdone things," conformist attitudes of docs, disorganization, sadistic love of suffering, enjoy assembly-line medicine, etc . . .) Financial impediments (high student loan debt, out of controlhospital dues/malpractice, low reimbursement, etc. . .)I know you may have other ideas here, but if you HAD to choosebetween these two what would y'all say?Second question is WHAT IF there was a fund to help primary caredocs start IMP practices. Write an essay, apply for the scholarship, get5-10K for start-up costs and some IMP training? Do you reallythink this would help at all????I tend to think the impediments are primarily psychological, but quite interested in the listserv take on this. And THANKS so muchfor the hospital dues input. I'm in the contemplative stage and getting ready to meet with the hospital bigwigs. I'll closewith some good one liners on the high hospital dues:"You mean you have to pay an admission fee to takeyour admission?""I find the 233% increase inhospitable & discourteousto courtesy staff physicians"We'll see where any of this gets me.Thanks again!PamelaNever miss a thing. Make Yahoo your homepage.

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[Guest guest]

As a newbie I'd say both but A>B. I have student loans to pay until I'm 75 but kids are grown and I live simply. I wish I had found this group earlier in the process. I bought a book from aafp for about $100 and it was really useless. Melody Lynn Ho wrote: Straz-that is because you have already passed through the "'A" and now are onto the ''B".Lynn To: From:

straz13comcast (DOT) netDate: Thu, 24 Jan 2008 10:59:01 -0500Subject: Re: In an IDEAL world . . . Depends on the point in your medical career and personal life. Financial impediments for me. Being the sole income for myself, my wife, 2 children and one on the way with all the usual costs such as mortgage, insurance, etc. etc., it's not very tempting to leave employment where I gross over 150,000/year with typical MD benefits to open an IMP. I'm determined to try because of my sanity and the lifestyle choices for my family. I plan a 1-2 year transition. I don't want to turn any younger MDs off to solo practice, but it's just in the past year or 2 (I finished residency in 1994), that I've become consciously competent in my practice of family medicine -

knock on wood. I see advantages in opening an IMP just out as residency as you are used to living on a small income, and your practice will grow financially as your financial burdens increase; but i question the competence, not the medical knowledge, of any family physician to practice solo right out of residency. Don't mean to insult anyone as I know some of you started IMPs right out of residency; I just believe that colleagues are important right out of residency to introduce one to the "real" world of medical practice. Straz The answer is selection "a".LL <jantonuccifchn (DOT) org> wrote: 1. B2. yes,maybe some In an

IDEAL world . . .What do you all think is the biggest impediment to widespreadadoption of the ideal practice model in primary care?(out of these two options)A) Psychological Impediments (Fear of running a business, lack of skill,lack of IMP mentors, lack of awareness that IMPs exist, med studentsdumbed down/brainwashed to do things "the same way as we've alwaysdone things," conformist attitudes of docs, disorganization, sadistic love of suffering, enjoy assembly-line medicine, etc . . .) Financial impediments (high student loan debt, out of controlhospital dues/malpractice, low reimbursement, etc. . .)I know you may have other ideas here, but if you HAD to choosebetween these two what would y'all say?Second question is WHAT IF there was a fund to help primary caredocs start IMP practices. Write an essay, apply for the scholarship, get5-10K

for start-up costs and some IMP training? Do you reallythink this would help at all????I tend to think the impediments are primarily psychological, but quite interested in the listserv take on this. And THANKS so muchfor the hospital dues input. I'm in the contemplative stage and getting ready to meet with the hospital bigwigs. I'll closewith some good one liners on the high hospital dues:"You mean you have to pay an admission fee to takeyour admission?""I find the 233% increase inhospitable & discourteousto courtesy staff physicians"We'll see where any of this gets me.Thanks again!Pamela Never miss a thing. Make Yahoo your homepage. Climb to the top of the charts! Play the word scramble challenge with star power. Play now!

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[Guest guest]

I suspect the answer is mostly a although b seems to be easier to acknowledge for those of us highly competitive typeA's who graduate from medical school. Most of those choosing career mostly on 'b' issues aren't in primary care...so maybe they'll lead the charge for IMP specialists!

Lynette I Iles MD 214 South Iowa Ste 3 Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

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Thanks, Lynn but there are still a few "A"s to deal with. Larry, you have a point; but that's the part of the "real" medical world that drives one toward opening their own practice. I meant that coming out of residency, I had a skewed view of the art of medical practice; and that I learned a lot about the art of medicine from the more experienced MDs around me. Straz Straz-that is because you have already passed through the "'A" and now are onto the ''B".LynnTo: From: straz13comcast (DOT) netDate: Thu, 24 Jan 2008 10:59:01 -0500Subject: Re: In an IDEAL world . . . Depends on the point in your medical career and personal life. Financial impediments for me. Being the sole income for myself, my wife, 2 children and one on the way with all the usual costs such as mortgage, insurance, etc. etc., it's not very tempting to leave employment where I gross over 150,000/year with typical MD benefits to open an IMP. I'm determined to try because of my sanity and the lifestyle choices for my family. I plan a 1-2 year transition. I don't want to turn any younger MDs off to solo practice, but it's just in the past year or 2 (I finished residency in 1994), that I've become consciously competent in my practice of family medicine - knock on wood. I see advantages in opening an IMP just out as residency as you are used to living on a small income, and your practice will grow financially as your financial burdens increase; but i question the competence, not the medical knowledge, of any family physician to practice solo right out of residency. Don't mean to insult anyone as I know some of you started IMPs right out of residency; I just believe that colleagues are important right out of residency to introduce one to the "real" world of medical practice. StrazThe answer is selection "a".LL <jantonuccifchn (DOT) org> wrote:1. B2. yes,maybe some In an IDEAL world . . .What do you all think is the biggest impediment to widespreadadoption of the ideal practice model in primary care?(out of these two options)A) Psychological Impediments (Fear of running a business, lack of skill,lack of IMP mentors, lack of awareness that IMPs exist, med studentsdumbed down/brainwashed to do things "the same way as we've alwaysdone things," conformist attitudes of docs, disorganization, sadistic love of suffering, enjoy assembly-line medicine, etc . . .) Financial impediments (high student loan debt, out of controlhospital dues/malpractice, low reimbursement, etc. . .)I know you may have other ideas here, but if you HAD to choosebetween these two what would y'all say?Second question is WHAT IF there was a fund to help primary caredocs start IMP practices. Write an essay, apply for the scholarship, get5-10K for start-up costs and some IMP training? Do you reallythink this would help at all????I tend to think the impediments are primarily psychological, but quite interested in the listserv take on this. And THANKS so muchfor the hospital dues input. I'm in the contemplative stage and getting ready to meet with the hospital bigwigs. I'll closewith some good one liners on the high hospital dues:"You mean you have to pay an admission fee to takeyour admission?""I find the 233% increase inhospitable & discourteousto courtesy staff physicians"We'll see where any of this gets me.Thanks again!PamelaNever miss a thing. Make Yahoo your homepage.Climb to the top of the charts! Play the word scramble challenge with star power. Play now!

[Guest guest]

i agree with the consensus that we start with a and then have to deal

with b.

i'm in residency now and nobody i've talked to, residents or faculty,

has heard of any of this stuff - other than the " boutique " idea.

i am somewhat perturbed by the assertion that i would need to work in

a corporate enterprise for years to learn to be even a competent

physician - perturbed on the basis of the medical care i and my family

have received from corporate enterprises.

if micropractice suffers from limited collegiality, can't we

compensate with virtual collegiality? on this list we discuss the

mechanics of practice, but what about a separate listserv or blog or

instant-messenger-mentor system, for brief discussion of individual

clinical issues, which we otherwise might discuss in the hallway with

our coworker? of course this goes on informally & prn, but how about

in a more stable, reliable format?

leigh

[Guest guest]

Hi Pam! I tend to agree the impediments are psychological. It feels quite alone even though this group is very supportive. Your idea for funds to start an IMP practice is right on target as well. LIPP has something like that, but the process seems cumbersome in my opinion. Have you any experience with getting supportive letters from insurance carriers, both medical and malpractice? I would think those companies would applaud more time with patients. I also wanted to let you know I spoke with Kurk son about his call group helping me with back up for inpatients. He's my PCP and will be checking with his call group at the next monthly meeting. Take care. Bob.roxywible wrote: What do you all think is the biggest impediment to widespreadadoption of the ideal practice model in primary care?(out of these two options)A) Psychological Impediments (Fear of running a business, lack of skill,lack of IMP mentors, lack of awareness that IMPs exist, med studentsdumbed down/brainwashed to do things "the same way as we've alwaysdone things," conformist attitudes of docs, disorganization, sadistic love of suffering, enjoy assembly-line medicine, etc . . .) Financial impediments (high student loan debt, out of controlhospital dues/malpractice, low reimbursement, etc. . .)I know you may have other ideas here, but if you HAD to choosebetween these two what would y'all say?Second

question is WHAT IF there was a fund to help primary caredocs start IMP practices. Write an essay, apply for the scholarship, get5-10K for start-up costs and some IMP training? Do you reallythink this would help at all????I tend to think the impediments are primarily psychological, but quite interested in the listserv take on this. And THANKS so muchfor the hospital dues input. I'm in the contemplative stage and getting ready to meet with the hospital bigwigs. I'll closewith some good one liners on the high hospital dues:"You mean you have to pay an admission fee to takeyour admission?""I find the 233% increase inhospitable & discourteousto courtesy staff physicians"We'll see where any of this gets me.Thanks again!Pamela

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