My Long Absence: I have been away too long from the internets and blogosphere. These forced, long absences always leave me a little depressed. But just as I was leaving for a conference in Chicago about a month ago, events forced me into an ideal micropractice. What does that mean? It means I'm short staffed and doing a lot of extra work myself.
There are two schools of thought when it comes to the business of running a medical practice. The conventional wisdom is that it's a waste of a doctor's productivity to do the small things - rooming a patient, getting the vital signs, giving shots, performing EKG's. It's a better use of resources to have someone else do those things while the doctor concentrates on treating the patient. Some physicians take it even farther - they have ancillary staff take the history and they just concern themselves with the exam and plan. (Not being someone who practices this way, I give them the benefit of the doubt and assume that they confirm that history before acting on it.) In theory, this allows them to see more patients. This is basically my style of practice. Except for this short staffed month.
This month, I've been almost practicing the ideal micropractice way. In the ideal micropractice the doctor does everything himself to reduce overhead. At least, that's the original intent, but even the micropractice guru has hired a nurse to help him out. One of my friends has a micropractice, and she keeps telling me that I do, too, but I don't believe I do. Once you start hiring staff, are you really a micropractice or just a solo practice?
The truth of the matter is that micropractices work only for micropopulations. Most people who practice that way limit themselves to 200-500 patients, whereas traditional practices handle 1500-2000. So which is better for the public good? A practice that can treat more patients and provide jobs or one that sees few patients and has no employees?
Is an unhappy physician better for the public good ? Some physicians will function better with staff, some without, some will work solo, some in large groups. The sad thing is when you are in the wrong place and end up hating the practice of medicine. There is no long term public benefit in someone's misery.
ReplyDeleteThis is true. Each practice, depending on its size, has to choose the right style for it. It would make no sense for a practice of 500 patients to have three support staff people. But it also makes no sense for a practice of 2000 patients to have no support staff.
ReplyDeleteWhere the "ideal micropractice" concept runs into trouble is when its advocates try to sell it as the better way to practice. It's one way to practice, but it isn't for everyone or for every location. (A solo doctor in an isolated rural town of 2,000 people who is the only doctor in town would have a rough time of it, for example. And one could argue that it would be unethical to limit himself to serving just 1/4 of the population if he's the only doctor in town.)
First, welcome back. You have been missed.
ReplyDeleteAs a person who has searched for a responsive doctor I would go with the micropractice. All too often what I have found is the nurse practices medicine and the doctor only worries about malpractice. I know a doctor who schedules patients every 10 min. Then complains that patients are ruining the practice by not being on time, causing phone calls to clarify prescriptions and resolving testing issues. The result is a practice always running behind schedule and doctors willing to see late patients for financial reasons.
My personal belief is that the more interaction with a patient the more a doctor will pick up on problems just by the side comment or watching the patient interact. I also believe testing will decline as doctors will have to deal with the reactions of patients to being told they need a test or the doctor performing a test. It is very easy to walk in, make a pronouncement, then walk out, leaving the dirty work to a nurse.
In terms of patient panels, would it be better to know 500 people, have a sane schedule and reliable income or not know 2000 people and wonder if you will make the payroll due to the staff that it will take to support such a large number. If I had a doctor's cell number, and knew they had a family, I would be very reluctant to call them in the middle of the night. If a doctor is in a large staffed practice I would assume someone is on call.
Whatever you do, don't beat yourself up. It is your life and you deserve to spend time with the kids and spouse, but do keep blogging.
Steve Lucas
Truthfully, it's usually not that bad at a patient panel of 2000 when fully staffed. Every business has times when stuff happens and they find themselves unexpectedly short-staffed. Especially small businesses. It just goes with the territory.
ReplyDeletePhysicians need to embrace concierge medicine as the future to running a profitable practice. By seeing less patients and not having to deal with insurance companies, physicians will be able to provide better care for their patients.
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