Is this type of practice economically sustainable?

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I always thought if one day I became an FM doc, I would love to run a solo practice. I would also like to maximize the time spent with each patient, so I won't be seeing more than 15 patients per day. Also, to maximize the income and minimize the overhead, I would not hire any employees. My wife will handle scheduling and billing, and I handle charting and vitals.

Realistically, could someone do this and still be able to generate an average income?

Thank you,

Originally Posted by Ibn Alnafis MD

I always thought if one day I became an FM doc, I would love to run a solo practice. I would also like to maximize the time spent with each patient, so I won't be seeing more than 15 patients per day. Also, to maximize the income and minimize the overhead, I would not hire any employees. My wife will handle scheduling and billing, and I handle charting and vitals.

Realistically, could someone do this and still be able to generate an average income?

Thank you,

look up gordon moore. if you have access to aafp's site, read his article. he advocates this model--actually, he wouldn't even have your wife there.

Short answer, "yes."

http://idealmedicalpractice.com/info.html

Here is a link to the article on AAFP:

http://www.aafp.org/fpm/2002/0300/p25.html

I absolutely love the idea of this practice model. He mentioned that he works part-time and it looks like he makes about $156K per year -- I wonder what his "part-time" looks like in terms of hours? Anyone have any real-world experience with this? I also wonder what his updated opinion is on this model. Very exciting possibility! Thanks for sharing!

Originally Posted by aterry

Here is a link to the article on AAFP:

http://www.aafp.org/fpm/2002/0300/p25.html

I absolutely love the idea of this practice model. He mentioned that he works part-time and it looks like he makes about $156K per year -- I wonder what his "part-time" looks like in terms of hours? Anyone have any real-world experience with this? I also wonder what his updated opinion is on this model. Very exciting possibility! Thanks for sharing!

Thank you for the source.

He sees 12pts/day and spends 30mins/pt, so I guess he works 6-7 hours/day. 157K/year for working 30-35hrs/wk 45wks/year is a great deal.

However, I noticed that some of his listed expenses don't make sense. For example, $100/month for insurance seems way too low. I thought malpractice insurance rates are about 20-30k/year. Another thing is his rent. $400/month seems too low for an office rental.

If I were him, I would avoid taking phone calls and let my wife handle that part. Scheduling can be done on-line. Also, since it's only a 6 hour per day job, I would do it six days a week to increase patients' access and generate 20% more income.

The biggest question for these type of practices in the future is what does the Affordable Care Act lead to? Will they all be squashed or swallowed by Accountable Care Organizations?

Originally Posted by Ibn Alnafis MD

I always thought if one day I became an FM doc, I would love to run a solo practice. I would also like to maximize the time spent with each patient, so I won't be seeing more than 15 patients per day. Also, to maximize the income and minimize the overhead, I would not hire any employees. My wife will handle scheduling and billing, and I handle charting and vitals.

Realistically, could someone do this and still be able to generate an average income?

Thank you,

Another one for you: http://www.aafp.org/fpm/2007/0600/p19.html

Originally Posted by War Machine

Another one for you: http://www.aafp.org/fpm/2007/0600/p19.html

I've been following Dr. Forrest for a while now. When you go cash-only and don't accept insurance, overhead costs drop like a stone.

One issue is how does such a practice handle a patient without the ability to pay? Access Healthcare makes it easy for a third party (like a relative or a church) to "sponsor" somebody else's healthcare, but this doesn't do much for the patient who is suddenly down on their luck. There may be a system in place to handle this type of scenario. I don't know. I just felt this issue ought to have been addressed in the article.

In an interesting twist on the rising movement to pay doctors for good outcomes, Dr. Forrest pays his patients to stay healthy. http://www.acchealth.com/ Click on the "Cash For Compliance" link on the right!

Originally Posted by sazerac

One issue is how does such a practice handle a patient without the ability to pay?

Probably the same way any other practice does. Options include:

1) Refer them to a free clinic.
2) Charge them a sliding scale fee based on income (a method typically used in free clinics).
3) Accept barter (more common in rural areas).
4) Provide charity care.

Originally Posted by sazerac

I've been following Dr. Forrest for a while now. When you go cash-only and don't accept insurance, overhead costs drop like a stone.

One issue is how does such a practice handle a patient without the ability to pay? Access Healthcare makes it easy for a third party (like a relative or a church) to "sponsor" somebody else's healthcare, but this doesn't do much for the patient who is suddenly down on their luck. There may be a system in place to handle this type of scenario. I don't know. I just felt this issue ought to have been addressed in the article.

In an interesting twist on the rising movement to pay doctors for good outcomes, Dr. Forrest pays his patients to stay healthy. http://www.acchealth.com/ Click on the "Cash For Compliance" link on the right!

I really like his model as it seems fairly straightforward. Cut overhead and charge directly. It's how it used to be long ago and times seem ripe for this arrangement to make a comeback.

Atlas MD, a low-cost concierge service ($50/month unlimited access), was recently interviewed on WBUR's Here & Now. Their complete staff is two doctors, one nurse.

http://hereandnow.wbur.org/2012/12/1...ne-health-care

Drs. Doug and Josh are also answering questions in the comments section of this web page, and several other low-cost healthcare models are mentioned there as well.

Originally Posted by aterry

Here is a link to the article on AAFP:

http://www.aafp.org/fpm/2002/0300/p25.html

I absolutely love the idea of this practice model. He mentioned that he works part-time and it looks like he makes about $156K per year -- I wonder what his "part-time" looks like in terms of hours? Anyone have any real-world experience with this? I also wonder what his updated opinion is on this model. Very exciting possibility! Thanks for sharing!

FYI, 156K in 2002 is equivalent to $198K in 2012 adjust for inflation. http://www.bls.gov/data/inflation_calculator.htm

Not bad at all!

Originally Posted by sazerac

Atlas MD, a low-cost concierge service ($50/month unlimited access), was recently interviewed on WBUR's Here & Now. Their complete staff is two doctors, one nurse.

http://hereandnow.wbur.org/2012/12/1...ne-health-care

Drs. Doug and Josh are also answering questions in the comments section of this web page, and several other low-cost healthcare models are mentioned there as well.

Just listened to the interview and read the article. I'm intrigued by this model.

Originally Posted by sazerac

Atlas MD, a low-cost concierge service ($50/month unlimited access), was recently interviewed on WBUR's Here & Now. Their complete staff is two doctors, one nurse.

http://hereandnow.wbur.org/2012/12/1...ne-health-care

Drs. Doug and Josh are also answering questions in the comments section of this web page, and several other low-cost healthcare models are mentioned there as well.

What about taking a vacation though? Do you just let your client base know as part of the plan that you take a certain amount of time off and they will need to see an associate/partner or are on their own? What about just taking off for the weekend?

500 patients x $50 per month x 12 months is a gross of $300,000. Other articles referenced said they should be pulling in roughly $200,000 after expenses. The onus really is on the doc to keep costs down because it maximizes their personal profitability. I like the idea. I am a long way away from having an opportunity to do something like this, but when I am closer I will definitely want to investigate more.

Originally Posted by Ibn Alnafis MD

He sees 12pts/day and spends 30mins/pt, so I guess he works 6-7 hours/day. 157K/year for working 30-35hrs/wk 45wks/year is a great deal.

Well, that's just time spent with patients. You have to factor in outside patient work (consults/charting etc etc) which probably brings his work week closer to 45-50 hrs/week.

Originally Posted by Ibn Alnafis MD

Thank you for the source.

He sees 12pts/day and spends 30mins/pt, so I guess he works 6-7 hours/day. 157K/year for working 30-35hrs/wk 45wks/year is a great deal.

However, I noticed that some of his listed expenses don't make sense. For example, $100/month for insurance seems way too low. I thought malpractice insurance rates are about 20-30k/year. Another thing is his rent. $400/month seems too low for an office rental.

If I were him, I would avoid taking phone calls and let my wife handle that part. Scheduling can be done on-line. Also, since it's only a 6 hour per day job, I would do it six days a week to increase patients' access and generate 20% more income.

The point of taking phone calls yourself is to answer your patient's questions/ call in their scripts/ ask them to come in for an appointment if its needed. Unless your wife has medical training it would probably be difficult for her to field those types of questions.

I like the idea of being able to spend a lot of time with a patient and having tons of time for charting and other administrative tasks and then being able to go home and relax. But I don't think the system could handle it if everyone decided they wanted to keep their patient panel low and stop taking insurance. It's definitely not for everybody either; you have to be good at drumming up business and you have to have really good relationships with other specialists, hospitals, etc. Not everyone's good at that.

Hello, i'm Dr Josh, the founder of AtlasMD, i noticed some traffic to my site from SDN and i thought i'd see if i could answer any questions.

You asked if this is viable? Absolutely. I started straight out of residency with zero patients, and 2.5 years later I'm full and i'm bringing on my 3rd doc.

Ask anytime, i'm passionate about helping docs realize that they can help their patients, love their life and enjoy practicing medicine.

The ideal micro practice has had a rocky history in part b/c it still is tied to the baggage of insurance companies. It can work, but i think the evolution will continue on to "direct primary care" insurance free practices.

Originally Posted by Cooperd0g

What about taking a vacation though? Do you just let your client base know as part of the plan that you take a certain amount of time off and they will need to see an associate/partner or are on their own? What about just taking off for the weekend?

500 patients x $50 per month x 12 months is a gross of $300,000. Other articles referenced said they should be pulling in roughly $200,000 after expenses. The onus really is on the doc to keep costs down because it maximizes their personal profitability. I like the idea. I am a long way away from having an opportunity to do something like this, but when I am closer I will definitely want to investigate more.

Actually, vacations work quite well. Our patients are very understanding that they get us 24/7 and they understand when we need family time. But also, its not a PAIN to be on call so often i'll take my call on vacation b/c the volume is manageable but i can always send it to my partner if needed.

Math - actually we take 600 pts so its more like $360 yr minus overhead and taxes so it still comes out to about $200k/yr. not bad for a non-ob non-hospital FP seeing 25 pts a week Overhead is the big variable. We had to go overboard with our office b/c the model is so new in our area. Future docs would be able to go for more basic/affordable offices and keep the difference.

Originally Posted by notbobtrustme

Well, that's just time spent with patients. You have to factor in outside patient work (consults/charting etc etc) which probably brings his work week closer to 45-50 hrs/week.

yeah, for the most part its 45 hr weeks i'd say. 9-5 M-F. But charting is minimal compared to insurance and coding. Think about it, just having to chart the visit and not to please an ins company?! Its nice and quick.

Originally Posted by sazerac

Drs. Doug and Josh are also answering questions in the comments section of this web page, and several other low-cost healthcare models are mentioned there as well.

if i didn't get to your question before, sorry, but happy to answer it now.

best,
josh

What I'm most curious about is how this model works when it comes to labs, tests, and medications. Does the patient still carry regular insurance to cover those types of things?


I'm thinking imaging and screening exams ( mammo, colonoscopy, etc.). Routine labs. The list goes on.


And. Do you maintain relationships with hospitals for referrals, admissions, etc.

I would absolutely LOVE to do something like this. I think it's far and away the way to go if you can.

Between this thread and the concierge FP thread, this makes me want to go into family practice. The idea of going back to a "rural doctor" type practice makes so much sense, and provides a way to actually care about your patients, and not have to please the system.

Thats great to hear!! Yes, we're passionate about showing medical students, residents and attending physicians how they can transition into new models like this to improve patient care, reduce costs and regain the love of medicine again!!

MJB - happy to help

Labs - took about 5 minutes to sign up with a local lab. the big national companies will do the same but our local lab gave the best rates. $2 cbc, $4.50 cmp, $3 tsh, $2 crp, etc All with no negotiation. It was just their physician discount.

Medicines - all but 4 states allow pretty unrestricted access for physicians to dispense to their patients from their office. The savings can be tremendous, one RA medicine is a $11 for us/mo, but $120 for generic and $940 namebrand at the pharmacy. I know what our pts prefer.

Routine labs - as noted above, for pennies on the dollar
Routine screening - if we can do it in the office, its free, including things like dexa, ekg, holter, spiro, home sleep apnea screening, audiometry, UA, STREP, etc

Mammo - $75-200 screening at local centers for cash
Colonoscopy/EGD $700-900 cash. Not cheap, but cheaper than ins. and i definitely see that being an area that REALLY comes down in cost b/c of ease of procedure and volume of pts needing screened.

Hospitalizations - we work with the hospitalist but you could admit your own pts under this model if you wanted to. Its another huge value to the patient for the type of admissions you'd be comfortable doing etc.

Referrals - drastically decrease the NEED for referrals when you have plenty of time to manage the patient. Curbsides - i can do more talking with my specialist for 2 minutes on the phone than can be done in weeks of waiting to see the specialist. That ensures they don't waste their time with inappropriate referrals. If the pt doesn't have ins, they pay cash, if they have a major medical (more common) they still pay cash. So referrals aren't too different right now. But i think you'll see innovative solutions to this in time too.

http://www.pointofcaredispensing.net/dispensing-faq/

hope i didn't miss anything
thanks
josh