Guest guest Posted March 7, 2003 Report Share Posted March 7, 2003 Thanks for the answers, Gordon, and the analysis. I already made up one of my own based on your previous FPM articles, and the numbers look similarly good to me. Could you be more specific about YOUR payer mix? What percent Medicare, Medicaid, PPD/Fee-for-service, HMO/capitation, cash-paying patients do you see? And could you give me the name of the MD in San Francisco (I'm in Southern California). I'd like to visit and see firsthand (with his/her permission, of course) what a solo-solo practice is like. Thanks again. -- Seto On Thursday, March 6, 2003, at 01:38 PM, L. Gordon wrote: > <rent a room model.xls> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 7, 2003 Report Share Posted March 7, 2003 I am starting on May 1, 2003 in the same town as the practice I just left. I sent out letters to about 580 of my previous families to inform them of this change. In two weeks I've had about 100 responses via mail, phone calls, visits to my house or chance run-ins in the grocery store. I think that is pretty significant! I'll keep you informed of my success story (I've always been a positive thinker). I am bouncing around some names for my new practice (I need to come up with one by Monday so the newspaper can print an article about me with my practice's name). Here's a few I've thought of - I'd like some objective input: K. Arnoult, MD (boring) Crossroads Family Medicine Vintage Family Medicine Hometown Family Medicine BTS Family Medicine (Buck the System) S & T Family Medicine ( & ) Frontline Family Medicine Mason-Dixon Family Medicine (I live right near the line) The newspaper article is going to highlight the return to old-style family medicine with a high-tech twist. Be kind in your comments - I'm not in marketing for a reason. K. Arnoult, MD Greencastle, PA Financial modeling > I'm attaching the " rent a room " model that I used to see if I'd get close > to income targets etc. It should help you test some assumptions. > About 70-80% of my charges are 99214. I also have a smattering of 99215 > visits. > > Payer mix means a lot. Look not only to the reimbursement but also to > payer hassle factor, as this drives up your non-compensated work. The sum > of these two things should drive the decision to participate. Keep your > list of insurances to a bare minimum, as more is not better in most cases. > > Will this model work in CA? Why not? > Plug the numbers into the model and see how it pans out. > There's a guy in San Francisco pulling it off (opened ~12/02). > > As you noted below, I'm half time in practice. I work half time with the > University of Rochester and the Institute for Healthcare Improvement. I > have heard from some others moving to solo practice that they had another > income stream as they made the transition. I don't think it is necessary, > but may be the right choice for some - you decide. > If you start off in full tilt practice with some patient volume that > follows you along, you'll be busy from the start and have good revenue from > the start. If you're starting from zero, you might want to do some > moonlighting or have some other means of support for the short term as you > get the practice up on its feet. The problem is that getting the practice > going means being available, and if you're tied up with other work, you're > not available. This is not impossible, but takes some work. > > If I were full time in my practice, I would be generating enough revenue to > take home ~ $150K before taxes, and if I had to pay for my own health care, > I'd deduct another $10K from that. Still pretty good income. > > Calls after 10P: Yup, still the same. > Since I'm only half time in practice, my panel is ~500. Maybe I would be > called twice per month after 10P if I had a panel of 1000, that's what I'd > predict, this is close to what I hear from those with larger practices > (where the doc takes all their own call). > > RE: Fears of going solo: your wife may be right. Pulling it off means > setting limits and boundaries on the work (matching capacity and > demand). Making a reasonable income is based on the financial > model. Administrative burden is lessened by having a good practice > management system, learning how to work with it, and keeping up with the work. > > I hope that this listserv can serve the goal of other success stories as > well as an honest forum from those working with many of the same issues. > Gordon > > At 09:18 AM 03/05/2003 -0800, you wrote: > >To Gordon, > >Thanks for taking the time to answer these questions, and for blazing a > >trail to a (hopefully) better way of practicing medicine. I, like many > >others, have been inspired by your articles on practice redesign and > >the model of the " solo-solo " physician. Having met you at the AAFP > >conference in San Diego last year, you seem like you are really > >enjoying what you are doing. > > > >I have been discussing your model w/ some medical-financial people and > >they are curious what your payer mix is, since they feel it all comes > >down to that as far as financial viability. If it is something very > >different than what we have here in California, then a model like yours > >might not work here. What proportion of visits are 99214s? 80%? > > > >Also, from a personal standpoint, I am wondering how often you get > >called at home, and what your patient panel size is. I know in your > >articles, you said you get called about once a month after 10PM. Is > >that still true? I have read other comments on your model, and some > >seem to feel that you have a " back-up " job doing academics which > >supplements your solo practice, and that is why you are able to > >survive. How much of your income comes from your solo practice? > > > >For the past 12 years, I have been with a large medical group (Kaiser) > >and take no call. While this may seem idyllic, it's a trade-off for > >seeing 24-28 patients/day with 15 minute per pt time slots. Like many > >others, I have found myself becoming increasingly dissatisfied with > >constantly running behind, and not having enough time to practice what > >I consider " quality " medicine. I do not have enough time left for > >charting and returning phone calls and handling abnormal labs/tests, > >and find myself spending my " off-hours " trying to catch up. I probably > >spend 60-70 hrs/week working, and I figure there's got to be a better > >way. > > > >My wife (who is also a physician, but no direct patient care) thinks > >that I should be happy with what I have, and that I just have to work > > " smarter " . She fears that going into a solo practice such as yours > >would be just as busy, unable to generate the same level of income, far > >more risky, and fraught with new administrative headaches that I don't > >have now. I would like to be able to give her other examples of > >physicians besides yourself who are succeeding with this slimmed-down > >model of medical practice. Can you tell me of other success stories > >which you have heard of? > > > >Thanks again, > > Seto > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 7, 2003 Report Share Posted March 7, 2003 > The newspaper article is going to highlight the return to old-style > family > medicine with a high-tech twist. Hey! That's what I want to do, too! Here's my 2 cents: K. Arnoult, MD (boring) - agree, no offense Crossroads Family Medicine - sounds too migrant Vintage Family Medicine - sounds like a wine label Hometown Family Medicine - better (unless you have Hometown Buffet Restaurants in your area) BTS Family Medicine (Buck the System) - initials sound impersonal S & T Family Medicine ( & ) - at least these mean something to you Frontline Family Medicine - sounds like a war zone Mason-Dixon Family Medicine (I live right near the line) - sounds old-style, dignified, best one to me How about Greencastle Family Medicine, since I assume that is you live/work? Greencastle-Antrim Family Medicine? From http://www.greencastlepa.org/ Walnut Hill Family Medicine? From http://www.greencastlemuseum.org/genealogy/Irwin/irwin.htm Tayamentasachta Family Medicine? - probably not Mercersburg Family Medicine, since a net search shows that you may be practicing there? Cumberland Valley Family Medicine? Tuscarosa Family Medicine? http://www.mercersburg.com/history/navigation.htm may give you other ideas of historic names Good luck on your solo practice and please let us know how it goes. -- Seto Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 7, 2003 Report Share Posted March 7, 2003 Already taken: Tuscarora (my ex-office), Greencastle, Antrim, Antietam & Cumberland Valley. They did get the good ones! We do have an abundance of buffets in the area - I am not aware of the hometown buffet - I'm sure many of my >300 lb folks could tell me! Tayamentasacta sounds too much like a legendary ape-like creature that lurks in forests - plus I can't spell it. Thanks for your input! Where are you practicing? Arnoult, MD Re: Financial modeling > > > > The newspaper article is going to highlight the return to old-style > > family > > medicine with a high-tech twist. > > Hey! That's what I want to do, too! Here's my 2 cents: > > K. Arnoult, MD (boring) - agree, no offense > Crossroads Family Medicine - sounds too migrant > Vintage Family Medicine - sounds like a wine label > Hometown Family Medicine - better (unless you have Hometown Buffet > Restaurants in your area) > BTS Family Medicine (Buck the System) - initials sound impersonal > S & T Family Medicine ( & ) - at least these mean something > to you > Frontline Family Medicine - sounds like a war zone > Mason-Dixon Family Medicine (I live right near the line) - sounds > old-style, dignified, best one to me > > How about Greencastle Family Medicine, since I assume that is you > live/work? > Greencastle-Antrim Family Medicine? From http://www.greencastlepa.org/ > Walnut Hill Family Medicine? From > http://www.greencastlemuseum.org/genealogy/Irwin/irwin.htm > Tayamentasachta Family Medicine? - probably not > > Mercersburg Family Medicine, since a net search shows that you may be > practicing there? > Cumberland Valley Family Medicine? > Tuscarosa Family Medicine? > http://www.mercersburg.com/history/navigation.htm may give you other > ideas of historic names > > Good luck on your solo practice and please let us know how it goes. > > -- Seto > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 7, 2003 Report Share Posted March 7, 2003 I like Vintage or Hometown given the type of practice you describe. It is very similar to what I have set up at Generations Health Care. Shaun MD Financial modeling > > > > I'm attaching the " rent a room " model that I used to see if I'd get close > > to income targets etc. It should help you test some assumptions. > > About 70-80% of my charges are 99214. I also have a smattering of 99215 > > visits. > > > > Payer mix means a lot. Look not only to the reimbursement but also to > > payer hassle factor, as this drives up your non-compensated work. The sum > > of these two things should drive the decision to participate. Keep your > > list of insurances to a bare minimum, as more is not better in most cases. > > > > Will this model work in CA? Why not? > > Plug the numbers into the model and see how it pans out. > > There's a guy in San Francisco pulling it off (opened ~12/02). > > > > As you noted below, I'm half time in practice. I work half time with the > > University of Rochester and the Institute for Healthcare Improvement. I > > have heard from some others moving to solo practice that they had another > > income stream as they made the transition. I don't think it is necessary, > > but may be the right choice for some - you decide. > > If you start off in full tilt practice with some patient volume that > > follows you along, you'll be busy from the start and have good revenue > from > > the start. If you're starting from zero, you might want to do some > > moonlighting or have some other means of support for the short term as you > > get the practice up on its feet. The problem is that getting the practice > > going means being available, and if you're tied up with other work, you're > > not available. This is not impossible, but takes some work. > > > > If I were full time in my practice, I would be generating enough revenue > to > > take home ~ $150K before taxes, and if I had to pay for my own health > care, > > I'd deduct another $10K from that. Still pretty good income. > > > > Calls after 10P: Yup, still the same. > > Since I'm only half time in practice, my panel is ~500. Maybe I would be > > called twice per month after 10P if I had a panel of 1000, that's what I'd > > predict, this is close to what I hear from those with larger practices > > (where the doc takes all their own call). > > > > RE: Fears of going solo: your wife may be right. Pulling it off means > > setting limits and boundaries on the work (matching capacity and > > demand). Making a reasonable income is based on the financial > > model. Administrative burden is lessened by having a good practice > > management system, learning how to work with it, and keeping up with the > work. > > > > I hope that this listserv can serve the goal of other success stories as > > well as an honest forum from those working with many of the same issues. > > Gordon > > > > At 09:18 AM 03/05/2003 -0800, you wrote: > > >To Gordon, > > >Thanks for taking the time to answer these questions, and for blazing a > > >trail to a (hopefully) better way of practicing medicine. I, like many > > >others, have been inspired by your articles on practice redesign and > > >the model of the " solo-solo " physician. Having met you at the AAFP > > >conference in San Diego last year, you seem like you are really > > >enjoying what you are doing. > > > > > >I have been discussing your model w/ some medical-financial people and > > >they are curious what your payer mix is, since they feel it all comes > > >down to that as far as financial viability. If it is something very > > >different than what we have here in California, then a model like yours > > >might not work here. What proportion of visits are 99214s? 80%? > > > > > >Also, from a personal standpoint, I am wondering how often you get > > >called at home, and what your patient panel size is. I know in your > > >articles, you said you get called about once a month after 10PM. Is > > >that still true? I have read other comments on your model, and some > > >seem to feel that you have a " back-up " job doing academics which > > >supplements your solo practice, and that is why you are able to > > >survive. How much of your income comes from your solo practice? > > > > > >For the past 12 years, I have been with a large medical group (Kaiser) > > >and take no call. While this may seem idyllic, it's a trade-off for > > >seeing 24-28 patients/day with 15 minute per pt time slots. Like many > > >others, I have found myself becoming increasingly dissatisfied with > > >constantly running behind, and not having enough time to practice what > > >I consider " quality " medicine. I do not have enough time left for > > >charting and returning phone calls and handling abnormal labs/tests, > > >and find myself spending my " off-hours " trying to catch up. I probably > > >spend 60-70 hrs/week working, and I figure there's got to be a better > > >way. > > > > > >My wife (who is also a physician, but no direct patient care) thinks > > >that I should be happy with what I have, and that I just have to work > > > " smarter " . She fears that going into a solo practice such as yours > > >would be just as busy, unable to generate the same level of income, far > > >more risky, and fraught with new administrative headaches that I don't > > >have now. I would like to be able to give her other examples of > > >physicians besides yourself who are succeeding with this slimmed-down > > >model of medical practice. Can you tell me of other success stories > > >which you have heard of? > > > > > >Thanks again, > > > Seto > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 8, 2003 Report Share Posted March 8, 2003 I suggested these names because of your locale. I did a Google search for Greencastle, PA and came upon some websites that talked a little about the history of the area. I'm currently practice in Pasadena, CA. But I figured that when (or if) I ever open my own solo practice, I would also want to choose a practice name that conveys old-time values, prestige and a local flavor. Good luck! -- Seto P.S. BTW, Hometown Buffet restaurants are called Old Country Buffet in Pennsylvania. http://www.buffet.com/ > Already taken: Tuscarora (my ex-office), Greencastle, Antrim, > Antietam & > Cumberland Valley. They did get the good ones! We do have an > abundance of > buffets in the area - I am not aware of the hometown buffet - I'm sure > many > of my >300 lb folks could tell me! Tayamentasacta sounds too much like > a > legendary ape-like creature that lurks in forests - plus I can't spell > it. > Thanks for your input! Where are you practicing? > Arnoult, MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2003 Report Share Posted March 9, 2003 Thank you for your inputs - I really appreciate it. I have been researching various "things" and have come up with some new ones to consider: Foundry Hill - my office will be on this site Tri-State - sounds like automotive care Buchanan - we are near the birthplace of Buchanan (he was a president) Allegheny - I think these mountains are around here somewhere Northwood - this was the name of my high school which closed after my class graduated (awww) Green Spring - this is a combo of my home town - Silver Spring and my new homestead - Greencastle -Antrim - the folks who founded Greencastle Bethesda - in Greek means "site of mercy" and was a healing pool in Jerusalem - also the birthplace of my first daughter - this is my favorite due to the meaning, however, it is a huge suburb of DC..... Moss Spring - this is the original water source for Greencastle Brown's Mill Chesapeake - I grew up in land - can you tell? Brookmoor - the street I grew up on - sounds Scot-Irish which is who founded Greencastle Kings Highway - a road in 1700's that connected Susquehanna and Potomac rivers Potomac - a river Susquehanna - a river Oriole - I went to med school in Baltimore Bannock - the county I did my residency in, in Pocatello, Idaho OK, it's getting late and my ideas are digressing. Thanks for the help - Monday is my deadline and if I can't get the right thing, Arnoult Family Practice it is! K. Arnoult, MD Greencastle, PA FW: Financial modeling re: self marketing YOU ARE the product and Dr ' s Homestyle Practice says it all. The best name or brand reaches way back into your personal and family history and resonates with deep meaning; it tells who you are. I am doing a solo-one staff practice in Gig Harbor WA and went through the same "identity crisis" What will my 'pubic persona' be??? I decided against a catchy or cute name. But I am getting catchy logos and nice graphics done for "Dennis Galvon MD" and have some alarmingly simple ads. My ads read: America's health crisis has taken away your relationship with your doctor..... ...... time for change. and my picture is on the right side under the .....time for change. My address, phone number and "Accepting new patients" is all there is. So simple, direct, - with a little color and assertiveness is GOOD! more power to you! Dr Dennis Galvon djgalvon@... -----Original Message-----From: Arnoult Sent: Friday, March 07, 2003 10:52 AMTo: Subject: Re: Financial modelingI am starting on May 1, 2003 in the same town as the practice I just left.I sent out letters to about 580 of my previous families to inform them ofthis change. In two weeks I've had about 100 responses via mail, phonecalls, visits to my house or chance run-ins in the grocery store. I thinkthat is pretty significant! I'll keep you informed of my success story(I've always been a positive thinker). I am bouncing around some names formy new practice (I need to come up with one by Monday so the newspaper canprint an article about me with my practice's name). Here's a few I'vethought of - I'd like some objective input: K. Arnoult, MD (boring) Crossroads Family Medicine Vintage Family Medicine Hometown Family Medicine BTS Family Medicine (Buck the System) S & T Family Medicine ( & ) Frontline Family Medicine Mason-Dixon Family Medicine (I live right near the line)The newspaper article is going to highlight the return to old-style familymedicine with a high-tech twist. Be kind in your comments - I'm not inmarketing for a reason. K. Arnoult, MDGreencastle, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2003 Report Share Posted March 9, 2003 Green Spring has a very healing sound to it. Gets my vote! Dennis Galvon -----Original Message-----From: Arnoult Sent: Saturday, March 08, 2003 7:42 PMTo: Subject: Re: Financial modeling Thank you for your inputs - I really appreciate it. I have been researching various "things" and have come up with some new ones to consider: Foundry Hill - my office will be on this site Tri-State - sounds like automotive care Buchanan - we are near the birthplace of Buchanan (he was a president) Allegheny - I think these mountains are around here somewhere Northwood - this was the name of my high school which closed after my class graduated (awww) Green Spring - this is a combo of my home town - Silver Spring and my new homestead - Greencastle -Antrim - the folks who founded Greencastle Bethesda - in Greek means "site of mercy" and was a healing pool in Jerusalem - also the birthplace of my first daughter - this is my favorite due to the meaning, however, it is a huge suburb of DC..... Moss Spring - this is the original water source for Greencastle Brown's Mill Chesapeake - I grew up in land - can you tell? Brookmoor - the street I grew up on - sounds Scot-Irish which is who founded Greencastle Kings Highway - a road in 1700's that connected Susquehanna and Potomac rivers Potomac - a river Susquehanna - a river Oriole - I went to med school in Baltimore Bannock - the county I did my residency in, in Pocatello, Idaho OK, it's getting late and my ideas are digressing. Thanks for the help - Monday is my deadline and if I can't get the right thing, Arnoult Family Practice it is! K. Arnoult, MD Greencastle, PA FW: Financial modeling re: self marketing YOU ARE the product and Dr ' s Homestyle Practice says it all. The best name or brand reaches way back into your personal and family history and resonates with deep meaning; it tells who you are. I am doing a solo-one staff practice in Gig Harbor WA and went through the same "identity crisis" What will my 'pubic persona' be??? I decided against a catchy or cute name. But I am getting catchy logos and nice graphics done for "Dennis Galvon MD" and have some alarmingly simple ads. My ads read: America's health crisis has taken away your relationship with your doctor..... ...... time for change. and my picture is on the right side under the .....time for change. My address, phone number and "Accepting new patients" is all there is. So simple, direct, - with a little color and assertiveness is GOOD! more power to you! Dr Dennis Galvon djgalvon@... -----Original Message-----From: Arnoult Sent: Friday, March 07, 2003 10:52 AMTo: Subject: Re: Financial modelingI am starting on May 1, 2003 in the same town as the practice I just left.I sent out letters to about 580 of my previous families to inform them ofthis change. In two weeks I've had about 100 responses via mail, phonecalls, visits to my house or chance run-ins in the grocery store. I thinkthat is pretty significant! I'll keep you informed of my success story(I've always been a positive thinker). I am bouncing around some names formy new practice (I need to come up with one by Monday so the newspaper canprint an article about me with my practice's name). Here's a few I'vethought of - I'd like some objective input: K. Arnoult, MD (boring) Crossroads Family Medicine Vintage Family Medicine Hometown Family Medicine BTS Family Medicine (Buck the System) S & T Family Medicine ( & ) Frontline Family Medicine Mason-Dixon Family Medicine (I live right near the line)The newspaper article is going to highlight the return to old-style familymedicine with a high-tech twist. Be kind in your comments - I'm not inmarketing for a reason. K. Arnoult, MDGreencastle, PA Quote Link to comment Share on other sites More sharing options...
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