Guest guest Posted August 5, 2006 Report Share Posted August 5, 2006 I don't have a true micropractice (I'm on the list because I am a micropractice wannabe), but I am an FP with a busy OB practice (60 del/yr). I have thought about how it would best fit into this model. I think it would work best using group prenatal visits. You could find a larger area, perhaps a conference room at the hospital, hire one of the OB nurses to help you for an hour or two a week and spend that time providing excellent prenatal education and group/individual visits. You meet with all of the patients for half hour and then break out one couple at a time, during which time, the nurse continues with educational topics, or comes and chaperones any exams. I would think that an excellent patient population, as an FP, for one of these micropractices would be one heavily weighed towards peds, and there is no better way to keep your practice young then to do OB. I have never heard anyone talk about group well child visits, but the same model might work just as well for the babies! Well child visit plus parenting support group all at the same time! Greg Hinson Caldwell wrote: Hello, Becky is very actively doing OB in a micropractice in Mason City, IA. She uses hospitalists for her other inpatients. I don't think she reads this list, but her partner Kathy Broman does. You can email her at bromanjenkinsnetconx (DOT) net Caldwell MD Tulare, CA > > Hello, > > I'm a third year resident in Family Medicine in Rochester NY, interested in ideal practice since medical school. I've been lurking on this list for several months now, and though I closely followed the thread about inpatient care vs using hospitalists, I haven't seen anyone address the issue of doing OB in micropractices. Is anyone making it work? If so, how? I know there is at least one OB/GYN provider on the list, but anyone in Family Medicine doing solo micropractice and OB? > > Challenges I see include: > - not enough volume in a small practice to get enough deliveries or keep skills current > - if you do have enough volume, dealing with 24/7 call (do you share OB coverage with other small practices? > - additional malpractice overhead > > Benefits I see include: > - applying all the IMP principles to quality, patient centered OB care > - having the flexibility and open access schedule to accomodate the interruptions of deliveries > - reimbursement at least balancing out malpractice? > > My personal interests lead me in the direction of doing outpatient practice with OB, but using hospitalists for inpatient coverage. > > > _@... > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2006 Report Share Posted August 5, 2006 ,I can see the e-mail address you posted just fine. SetoSouth Pasadena, CAIt looks like the email address for Becky got truncated in last post.I will try again:bromanjenkinsnetconx (DOT) net Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2006 Report Share Posted August 5, 2006 About 20 years ago when I was working in the National Health Service corps I had a solo practice with a nurse practioner . I did a lot of ob. I would take continuous call for my own patients during the week but I had coverage with another group on the weekends. We did group visits which the patients liked a lot. While I was seeing a patient my nurse practitioner would be giving classes on various topics. The patients often would stay friends and thus developed a support network when the children were born. We did have parenting classes when the parents would bring their babies but we would only do weight checks because the individual baby checks took too long with all the immunizations to do a true group visit. At the time we had never heard of anyone doing group visits. It just seemed the best way to dealing with a very young low income population that hadn't had much health education.Larry Lindeman MDI don't have a true micropractice (I'm on the list because I am a micropractice wannabe), but I am an FP with a busy OB practice (60 del/yr). I have thought about how it would best fit into this model. I think it would work best using group prenatal visits. You could find a larger area, perhaps a conference room at the hospital, hire one of the OB nurses to help you for an hour or two a week and spend that time providing excellent prenatal education and group/individual visits. You meet with all of the patients for half hour and then break out one couple at a time, during which time, the nurse continues with educational topics, or comes and chaperones any exams.I would think that an excellent patient population, as an FP, for one of these micropractices would be one heavily weighed towards peds, and there is no better way to keep your practice young then to do OB. I have never heard anyone talk about group well child visits, but the same model might work just as well for the babies! Well child visit plus parenting support group all at the same time!Greg Hinson Caldwell wrote:Hello,Becky is very actively doing OB in a micropractice in MasonCity, IA. She uses hospitalists for her other inpatients. I don'tthink she reads this list, but her partner Kathy Broman does. You canemail her at bromanjenkinsnetconx (DOT) netAlex Caldwell MDTulare, CA>> Hello,> > I'm a third year resident in Family Medicine in Rochester NY,interested in ideal practice since medical school. I've been lurkingon this list for several months now, and though I closely followed thethread about inpatient care vs using hospitalists, I haven't seenanyone address the issue of doing OB in micropractices. Is anyonemaking it work? If so, how? I know there is at least one OB/GYNprovider on the list, but anyone in Family Medicine doing solomicropractice and OB?> > Challenges I see include: > - not enough volume in a small practice to get enough deliveries orkeep skills current> - if you do have enough volume, dealing with 24/7 call (do you shareOB coverage with other small practices?> - additional malpractice overhead> > Benefits I see include: > - applying all the IMP principles to quality, patient centered OB care> - having the flexibility and open access schedule to accomodate theinterruptions of deliveries> - reimbursement at least balancing out malpractice?> > My personal interests lead me in the direction of doing outpatientpractice with OB, but using hospitalists for inpatient coverage. > > > _@...> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2006 Report Share Posted August 7, 2006 In this day and age I do not see how an FP can afford to deliver babies, malpractice wise. I’m not sure of the exact numbers, but I would think you would have to deliver a lot of babies to justify the huge increase in malpractice costs. I would guess at least 1 – 2 deliveries per wk. I’ve never looked into it (because I have no interest in it), but I bet my annual policy would cost at least $15,000 - $25,000 more per year to allow be to do obstetrics. Unless we get some type of federal tort reform I think the days of the local FP delivering babies will be over in the next few years. Re: Re: Anyone diong OB? About 20 years ago when I was working in the National Health Service corps I had a solo practice with a nurse practioner . I did a lot of ob. I would take continuous call for my own patients during the week but I had coverage with another group on the weekends. We did group visits which the patients liked a lot. While I was seeing a patient my nurse practitioner would be giving classes on various topics. The patients often would stay friends and thus developed a support network when the children were born. We did have parenting classes when the parents would bring their babies but we would only do weight checks because the individual baby checks took too long with all the immunizations to do a true group visit. At the time we had never heard of anyone doing group visits. It just seemed the best way to dealing with a very young low income population that hadn't had much health education. Larry Lindeman MD On Aug 5, 2006, at 9:00 AM, Greg & Amy Hinson wrote: I don't have a true micropractice (I'm on the list because I am a micropractice wannabe), but I am an FP with a busy OB practice (60 del/yr). I have thought about how it would best fit into this model. I think it would work best using group prenatal visits. You could find a larger area, perhaps a conference room at the hospital, hire one of the OB nurses to help you for an ho! ur or two a week and spend that time providing excellent prenatal educ ation and group/individual visits. You meet with all of the patients for half hour and then break out one couple at a time, during which time, the nurse continues with educational topics, or comes and chaperones any exams. I would think that an excellent patient population, as an FP, for one of these micropractices would be one heavily weighed towards peds, and there is no better way to keep your practice young then to do OB. I have never heard anyone talk about group well child visits, but the same model might work just as well for the babies! Well child visit plus parenting support group all at the same time! Greg! Hinson Caldwell wrote: Hello, Becky is very actively doing OB in a micropractice in Mason City, IA. She uses hospitalists for h er other inpatients. I don't think she reads this list, but her partner Kathy Broman does. You can email her at bromanjenkinsnetconx (DOT) net Caldwell MD Tulare, CA > > Hello, > > I'm a third year resident in Family Medicine in Rochester NY, interested in ideal practice since medical school. I've been lurking on this list for several months now, and though I closely followed the thread about inpatient care vs using hospitalists, I haven't seen anyone address the issue of doing OB in micropractices. Is anyone making it work? If so, how? I know there is at least one OB/GYN provider on the list, but anyone in Family Medicine doing solo micropractice and O! B? > > Challenges I see include: > - not enough volume in a small practice to get enough deliveries or keep skills current > - if you do have enough volume, de aling with 24/7 call (do you share OB coverage with other small practices? > - additional malpractice overhead > > Benefits I see include: > - applying all the IMP principles to quality, patient centered OB care > - having the flexibility and open access schedule to accomodate the interruptions of deliveries > - reimbursement at least balancing out malpractice? ! > > My personal interests lead me in the direction of doing outpatient practice with OB, but using hospitalists for inpatient coverage. > > > ! _@... > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2006 Report Share Posted August 7, 2006 In this day and age I do not see how an FP can afford to deliver babies, malpractice wise. I’m not sure of the exact numbers, but I would think you would have to deliver a lot of babies to justify the huge increase in malpractice costs. I would guess at least 1 – 2 deliveries per wk. I’ve never looked into it (because I have no interest in it), but I bet my annual policy would cost at least $15,000 - $25,000 more per year to allow be to do obstetrics. Unless we get some type of federal tort reform I think the days of the local FP delivering babies will be over in the next few years. Re: Re: Anyone diong OB? About 20 years ago when I was working in the National Health Service corps I had a solo practice with a nurse practioner . I did a lot of ob. I would take continuous call for my own patients during the week but I had coverage with another group on the weekends. We did group visits which the patients liked a lot. While I was seeing a patient my nurse practitioner would be giving classes on various topics. The patients often would stay friends and thus developed a support network when the children were born. We did have parenting classes when the parents would bring their babies but we would only do weight checks because the individual baby checks took too long with all the immunizations to do a true group visit. At the time we had never heard of anyone doing group visits. It just seemed the best way to dealing with a very young low income population that hadn't had much health education. Larry Lindeman MD On Aug 5, 2006, at 9:00 AM, Greg & Amy Hinson wrote: I don't have a true micropractice (I'm on the list because I am a micropractice wannabe), but I am an FP with a busy OB practice (60 del/yr). I have thought about how it would best fit into this model. I think it would work best using group prenatal visits. You could find a larger area, perhaps a conference room at the hospital, hire one of the OB nurses to help you for an ho! ur or two a week and spend that time providing excellent prenatal educ ation and group/individual visits. You meet with all of the patients for half hour and then break out one couple at a time, during which time, the nurse continues with educational topics, or comes and chaperones any exams. I would think that an excellent patient population, as an FP, for one of these micropractices would be one heavily weighed towards peds, and there is no better way to keep your practice young then to do OB. I have never heard anyone talk about group well child visits, but the same model might work just as well for the babies! Well child visit plus parenting support group all at the same time! Greg! Hinson Caldwell wrote: Hello, Becky is very actively doing OB in a micropractice in Mason City, IA. She uses hospitalists for h er other inpatients. I don't think she reads this list, but her partner Kathy Broman does. You can email her at bromanjenkinsnetconx (DOT) net Caldwell MD Tulare, CA > > Hello, > > I'm a third year resident in Family Medicine in Rochester NY, interested in ideal practice since medical school. I've been lurking on this list for several months now, and though I closely followed the thread about inpatient care vs using hospitalists, I haven't seen anyone address the issue of doing OB in micropractices. Is anyone making it work? If so, how? I know there is at least one OB/GYN provider on the list, but anyone in Family Medicine doing solo micropractice and O! B? > > Challenges I see include: > - not enough volume in a small practice to get enough deliveries or keep skills current > - if you do have enough volume, de aling with 24/7 call (do you share OB coverage with other small practices? > - additional malpractice overhead > > Benefits I see include: > - applying all the IMP principles to quality, patient centered OB care > - having the flexibility and open access schedule to accomodate the interruptions of deliveries > - reimbursement at least balancing out malpractice? ! > > My personal interests lead me in the direction of doing outpatient practice with OB, but using hospitalists for inpatient coverage. > > > ! _@... > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2006 Report Share Posted August 7, 2006 It varies tremendously state to state. In Massachusetts I pay $25K for a FP-nonoperative OB policy. Since the average reimbursement is $1,900 for a delivery, quick math tells you that I break even on OB after 13 deliveries. I do approx 55 deliveries per year, so it is worth it. (It's not quite as cut and dry as that, of course, because if I were not doing prenatal care, then there would be more visits in the office that I could bill for, what with prenatal care being lumped into the global fee you get for OB care and delivery.) The other thing that is nice about providing obstetrical care is that it changes the overall look of your practice. It helps me to do more gyn care and more well child care, all of which, I think, makes my practice more of a true " family " practice. Not that you cannot do this otherwise, but so many of my colleagues where I have worked ended up with practices that were indistinguishable from a general internist's. Greg Brock DO wrote: > In this day and age I do not see how an FP can afford to deliver > babies, malpractice wise. I’m not sure of the exact numbers, but I > would think you would have to deliver a lot of babies to justify the > huge increase in malpractice costs. I would guess at least 1 – 2 > deliveries per wk. I’ve never looked into it (because I have no > interest in it), but I bet my annual policy would cost at least > $15,000 - $25,000 more per year to allow be to do obstetrics. Unless > we get some type of federal tort reform I think the days of the local > FP delivering babies will be over in the next few years. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2006 Report Share Posted August 7, 2006 It varies tremendously state to state. In Massachusetts I pay $25K for a FP-nonoperative OB policy. Since the average reimbursement is $1,900 for a delivery, quick math tells you that I break even on OB after 13 deliveries. I do approx 55 deliveries per year, so it is worth it. (It's not quite as cut and dry as that, of course, because if I were not doing prenatal care, then there would be more visits in the office that I could bill for, what with prenatal care being lumped into the global fee you get for OB care and delivery.) The other thing that is nice about providing obstetrical care is that it changes the overall look of your practice. It helps me to do more gyn care and more well child care, all of which, I think, makes my practice more of a true " family " practice. Not that you cannot do this otherwise, but so many of my colleagues where I have worked ended up with practices that were indistinguishable from a general internist's. Greg Brock DO wrote: > In this day and age I do not see how an FP can afford to deliver > babies, malpractice wise. I’m not sure of the exact numbers, but I > would think you would have to deliver a lot of babies to justify the > huge increase in malpractice costs. I would guess at least 1 – 2 > deliveries per wk. I’ve never looked into it (because I have no > interest in it), but I bet my annual policy would cost at least > $15,000 - $25,000 more per year to allow be to do obstetrics. Unless > we get some type of federal tort reform I think the days of the local > FP delivering babies will be over in the next few years. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2006 Report Share Posted August 7, 2006 OB rider- malpractice in RI for deliveries for FPs: $60,000 per year!!! Lynn > >Reply-To: >To: < > >Subject: RE: Re: Anyone diong OB? >Date: Mon, 7 Aug 2006 09:53:59 -0400 > >In this day and age I do not see how an FP can afford to deliver babies, >malpractice wise. I'm not sure of the exact numbers, but I would think you >would have to deliver a lot of babies to justify the huge increase in >malpractice costs. I would guess at least 1 - 2 deliveries per wk. I've >never looked into it (because I have no interest in it), but I bet my >annual >policy would cost at least $15,000 - $25,000 more per year to allow be to >do >obstetrics. Unless we get some type of federal tort reform I think the >days >of the local FP delivering babies will be over in the next few years. > > > > > > > > Re: Re: Anyone diong OB? > > > >About 20 years ago when I was working in the National Health Service corps >I >had a solo practice with a nurse practioner . I did a lot of ob. I would >take continuous call for my own patients during the week but I had coverage >with another group on the weekends. We did group visits which the patients >liked a lot. While I was seeing a patient my nurse practitioner would be >giving classes on various topics. The patients often would stay friends and >thus developed a support network when the children were born. We did have >parenting classes when the parents would bring their babies but we would >only do weight checks because the individual baby checks took too long with >all the immunizations to do a true group visit. At the time we had never >heard of anyone doing group visits. It just seemed the best way to dealing >with a very young low income population that hadn't had much health >education. > > > >Larry Lindeman MD > > > > > > > > > >I don't have a true micropractice (I'm on the list because I am a >micropractice wannabe), but I am an FP with a busy OB practice (60 del/yr). >I have thought about how it would best fit into this model. I think it >would >work best using group prenatal visits. You could find a larger area, >perhaps >a conference room at the hospital, hire one of the OB nurses to help you >for >an ho! ur or two a week and spend that time providing excellent prenatal >educ ation and group/individual visits. You meet with all of the patients >for half hour and then break out one couple at a time, during which time, >the nurse continues with educational topics, or comes and chaperones any >exams. > >I would think that an excellent patient population, as an FP, for one of >these micropractices would be one heavily weighed towards peds, and there >is >no better way to keep your practice young then to do OB. I have never heard >anyone talk about group well child visits, but the same model might work >just as well for the babies! Well child visit plus parenting support group >all at the same time! > >Greg! Hinson > > > Caldwell wrote: > >Hello, > >Becky is very actively doing OB in a micropractice in Mason >City, IA. She uses hospitalists for h er other inpatients. I don't >think she reads this list, but her partner Kathy Broman does. You can >email her at <mailto:bromanjenkins%40netconx.net> >bromanjenkins@... > > Caldwell MD >Tulare, CA > > > > > > Hello, > > > > I'm a third year resident in Family Medicine in Rochester NY, >interested in ideal practice since medical school. I've been lurking >on this list for several months now, and though I closely followed the >thread about inpatient care vs using hospitalists, I haven't seen >anyone address the issue of doing OB in micropractices. Is anyone >making it work? If so, how? I know there is at least one OB/GYN >provider on the list, but anyone in Family Medicine doing solo >micropractice and O! B? > > > > Challenges I see include: > > - not enough volume in a small practice to get enough deliveries or >keep skills current > > - if you do have enough volume, de aling with 24/7 call (do you share >OB coverage with other small practices? > > - additional malpractice overhead > > > > Benefits I see include: > > - applying all the IMP principles to quality, patient centered OB care > > - having the flexibility and open access schedule to accomodate the >interruptions of deliveries > > - reimbursement at least balancing out malpractice? >! > > > My personal interests lead me in the direction of doing outpatient >practice with OB, but using hospitalists for inpatient coverage. > > > > > > ! _@... > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2006 Report Share Posted August 7, 2006 What happens if a mother needs to go to c-section, especially stat? Who handles it? As frequent as those are these days, I don't think I would feel comfortable getting my name on the chart & then not being able to finish the case because I do not do surgical obstetrics. I guess for me it comes down to the fact that I just never really enjoyed the OB stuff: too anxiety provoking when things don't go right (dystocia, concerning heart tones, etc) & too much blame thrown around. If you enjoy it then by all means go for it. Re: Re: Anyone diong OB? It varies tremendously state to state. In Massachusetts I pay $25K for a FP-nonoperative OB policy. Since the average reimbursement is $1,900 for a delivery, quick math tells you that I break even on OB after 13 deliveries. I do approx 55 deliveries per year, so it is worth it. (It's not quite as cut and dry as that, of course, because if I were not doing prenatal care, then there would be more visits in the office that I could bill for, what with prenatal care being lumped into the global fee you get for OB care and delivery.) The other thing that is nice about providing obstetrical care is that it changes the overall look of your practice. It helps me to do more gyn care and more well child care, all of which, I think, makes my practice more of a true " family " practice. Not that you cannot do this otherwise, but so many of my colleagues where I have worked ended up with practices that were indistinguishable from a general internist's. Greg Brock DO wrote: > In this day and age I do not see how an FP can afford to deliver > babies, malpractice wise. I'm not sure of the exact numbers, but I > would think you would have to deliver a lot of babies to justify the > huge increase in malpractice costs. I would guess at least 1 - 2 > deliveries per wk. I've never looked into it (because I have no > interest in it), but I bet my annual policy would cost at least > $15,000 - $25,000 more per year to allow be to do obstetrics. Unless > we get some type of federal tort reform I think the days of the local > FP delivering babies will be over in the next few years. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2006 Report Share Posted August 7, 2006 It's definitely a " to each his own " type of thing. If I have a case that ends up as a c-section, I consult someone to come and do it for me and I assist. In my case, I am in a small enough town that we do not have an OB (talk about anxiety-provoking) so I call a general surgeon to come help me. (He doesn't mind because he gets the bulk of the billing and only spends an hour or so at the hospital.) It works out fine for all involved. It is definitely the most anxiety provoking aspect of my practice, but it is also the most gratifying. Greg Brock DO wrote: > What happens if a mother needs to go to c-section, especially stat? Who > handles it? As frequent as those are these days, I don't think I would > feel > comfortable getting my name on the chart & then not being able to > finish the > case because I do not do surgical obstetrics. I guess for me it comes down > to the fact that I just never really enjoyed the OB stuff: too anxiety > provoking when things don't go right (dystocia, concerning heart > tones, etc) > & too much blame thrown around. If you enjoy it then by all means go for > it. > > > Quote Link to comment Share on other sites More sharing options...
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