What is your opinion of the Ideal Micropractice?

[eyesarecool]

Just wanted to see what y'all thought about it.

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[Doowai]

I am not sure what you mean by micropractice?
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GO SUNS!

 

[deleted87716]

In a nutshell, the IMP is basically a new take on the traditional solo-practice model infused with 21st-century technology.

It's not for everyone (doctors or patients).

It doesn't solve everything (IMPs still must function in the "real world").

It's not for the faint of heart (there's a considerable amount of personal risk involved in bucking the status quo).

No two IMPs are created equal. What worked for one person may not work for another.

That being said, it's a viable option for doctors and/or patients who are dissatisfied with traditional practices.

More info here: http://www.idealmedicalpractices.org/static/medeconIMP.pdf (this article even mentions my friend, John Brady).

 

[Doowai]

In a nutshell, the IMP is basically a new take on the traditional solo-practice model infused with 21st-century technology.

It's not for everyone (doctors or patients).

It doesn't solve everything (IMPs still must function in the "real world").

It's not for the faint of heart (there's a considerable amount of personal risk involved in bucking the status quo).

No two IMPs are created equal. What worked for one person may not work for another.

That being said, it's a viable option for doctors and/or patients who are dissatisfied with traditional practices.

More info here: http://www.idealmedicalpractices.org/static/medeconIMP.pdf (this article even mentions my friend, John Brady).

I finally read the article. Again, not to sound egotistical or pedantic, but it certainly sounds like a chiropractic practice. I like the guy who rented a room out of a PT office.

I once did something similar - had a room in another office, had acesss to everything - for free. I did not pay any money for rent. I will post about how I did that in my thread of 16 years of practice tips.

 

[primadonna22274]

Some of it sounds nice. Getting off the medicine treadmill for sure sounds nice.

But what happens if you get sick or take vacation? How does call work? Are these micropractitioners managing their own hospital patients or do they go to the hospitalist? I guess there could be a dozen permutations of the scheme.

Interesting idea though.

L.

 

[deleted87716]

But what happens if you get sick or take vacation? How does call work? Are these micropractitioners managing their own hospital patients or do they go to the hospitalist? I guess there could be a dozen permutations of the scheme.

Pretty much.

If you're outpatient-only, hospitalizations are handled the same way they are in a traditional outpatient-only practice. They go to the hospitalist service.

As for call coverage, when you're in town, you typically take call yourself, although there's really nothing to keep you from joining a call group with other physicians, if you prefer. Keep in mind that in a typical low-volume solo practice, the number of phone calls you can expect to receive on any given night will probably range from zero to maybe one or two. From everything I've seen, the more confident your patients are in their ability to be seen and taken care of during the day, the less likely they are to bother you at night.

Vacations can be handled in a variety of ways, from remaining on-call via pager or cell phone, referring people to the ER or urgent care when necessary, or having somebody covering your office or available in another office in the event somebody needs to be seen urgently. I cover for John when he's out of town. Over the past several years, I've only seen three or four of his patients.

 

[Doowai]

*sigh* I do find it a bit depressing though that I am about to start residency in a few weeks, and something similar to what I was doing with chiropractic is where I probably will be heading. My last chiropractic office was medicare based (Medicare does not reiumburse chiropractors for anything other than manual manipulation - not for the required exam, not for x-rays, nothing) working less than 20 hours per week , seeing about 40 patients per week and I was doing roughly what the medical doctors in these micropractices are doing dollar wise.

Have I given up 6 years of my professional life (4 in med school and now 2 years waiting to get into residency) and another 3 working 80 hours per week for only $50K a year - to go back to a practice lifestyle that nets me only $60-70K per year?

I really just would have thought medicine would reimburse better than that. I mean, it just seems if I had that same medicare practice and could charge for my x-rays, and exams alone - I would have made at least twice as much money on the same work. I just don't see how one person works a 3/4 schedule ( I am guessing 30 hours per week) to make what I made in 15 as a chiropractor ...FROM MEDICARE no less, the worst paying method for chiropractic.

*sigh* I dunno

 

[deleted87716]

I do find it a bit depressing though that I am about to start residency in a few weeks, and something similar to what I was doing with chiropractic is where I probably will be heading.

I dunno 'bout you, but the only chiropractors that I've known who made decent money ran high-volume personal-injury mills. I think we're talking apples and oranges here.

My last chiropractic office was medicare based

I don't know anyone in medicine who sees primarily Medicare. Frankly, you'd starve. Most of us cap it off at something around 20-25%. Medicare is typically one of the worst payers. Medicaid is a whole 'nother story, and is basically charity care. Most Medicaid payments don't even cover your overhead.

I just don't see how one person works a 3/4 schedule ( I am guessing 30 hours per week) to make what I made

If you're in an IMP that accepts third-party reimbursement, the key is to minimize your overhead. That's the only way you can see fewer patients than you would in a traditional practice and still earn an income that's comparable to your peers. Most physicians in successful micropractices are making close to what they made in traditional practices. Many are doing better.

 

[Doowai]

I dunno 'bout you, but the only chiropractors that I've known who made decent money ran high-volume personal-injury mills. I think we're talking apples and oranges here.

Depends on what you call decent money. For me decent is $120-280K positive cash flow. I have a good friend netting about $200K, and it is certainly not personal injury mill. The personal injury mills I know out here make BIG money - have a corporate jet they let attorneys they do business with fly for free, have box seats at the pro-ball games that they lett attorneys they do business with use for free etc. They have 8 or 9 offices, and do really really big money - millions. But I know many non-high volume, non-personal injury practices making $100-200K on 30 hours per week. But then again I don't really know any chiro's just starting out - I am old.

I don't know anyone in medicine who sees primarily Medicare. Frankly, you'd starve. Most of us cap it off at something around 20-25%. Medicare is typically one of the worst payers. Medicaid is a whole 'nother story, and is basically charity care. Most Medicaid payments don't even cover your overhead.

Yeah my last practice was probably 95% Medicare. I really liked it in many ways - I had alot (well not alot - maybe 10) of patients from 8 until 2 and then was basically done. But I worked it less than 20 hours per week, 3 days per week. Netted about $60 -75K, according to my IRS return.

If you're in an IMP that accepts third-party reimbursement, the key is to minimize your overhead. That's the only way you can see fewer patients than you would in a traditional practice and still earn an income that's comparable to your peers. Most physicians in successful micropractices are making close to what they made in traditional practices. Many are doing better.

That is good to know. I know how to minimize overhead in a chiropractic practice, and think I have an idea of how to do it in medicine - except for some supplies it should not be that much different than chiropractic (especially for the rheum/sports medicine/PMR type practice I envision), but then again you never know until you are doing it - so we will see. So just to make sure I understand you - the guys you know in successful micropractices probably are netting $100-200K....right? Probably grossing $150-300K per year....right?

 

[deleted87716]

So just to make sure I understand you - the guys you know in successful micropractices probably are netting $100-200K....right?

The numbers I've seen quoted are usually in the $100-150K range (net). You don't often find individuals who are willing to share their income with total strangers, much less online, but it's not unusual to read that most earn somewhere between 70%-90% of what they did in a traditional practice.

Keep in mind that many of these practices take a while to build up to full panel size, and many doctors in micropractices are working less than full-time hours by choice. They've made a conscious decision not to sacrifice lifestyle for income.

As an example, SoloDoc runs the numbers in his blog here: http://akifox.blogspot.com/2007_03_01_archive.html

More info here:

http://seattletimes.nwsource.com/html/localnews/2003871069_microdoctors07m.html

http://www.concordmonitor.com/apps/pbcs.dll/article?AID=/20070609/REPOSITORY/706090331/1013/NEWS03

http://www.acponline.org/clinical_i...ations/acp_internist/sep07/micropractices.htm

http://www.idahostatesman.com/business/story/103158.html

http://idealmicropractices.wikia.com/wiki/Why_start_your_own_practice?

And, last but not least, the Ideal Micro Practices Wiki: http://idealmicropractices.wikia.com/wiki/Main_Page