Practice Transformation

[Guest guest]

Looking for advice from doctors on the list working alternative

practices. You know how when you hold a piece of paper over a flame

and it starts to turn brown just that instant before it bursts into

flames? That's me right now. I am so close to burn-out.

I have a solo practice with a 32-hr-a-week NP, an MA, and a

receptionist. I have fairly low overhead, but I have it in part

because I do all the office management work, e.g., ordering supplies,

the books, payroll, etc. I practice in an area where there is a lot of

demand. There are now only 4 doctors here providing care to a

population that averages 20,000. The other three doctors have been

here longer and all practice independently as well. (The hospital is

recruiting, but it is hard to find a doctor to come into this

environment.)

I am only seeing 25 patients a day (and the NP averages 15), but I am

only seeing that number by limiting access. I could probably see 40 a

day if I opened the gates. Limiting access is a stressful thing and it

means that I spend another 1.5 hours a day answering emails and phone

messages. (And therefore providing less then adequate care.)

I recognize now that I let it get out of hand. But I am not sure how

to fix it. I cannot fire a third of my patients. Not at a time when

two of the other three doctors are also no longer taking new patients.

In the heat of my burnout, I can only see two solutions. One is to

move. Pull up shop and start over elsewhere. That is the easy way out,

that is for sure. And my stress has my family stressed enough to where

they would probably pull for this option at this point.

The other idea is to change to a cash-based practice. The good thing

about this is I would lower my overhead even further. I could probably

do away with 1 or 2 of my employees. I would likely slow way down. I

could add extra services, evening or weekend hours, if necessary. I

would opt out of Medicare too.

This seems like a smart move, since the area is underserved enough

that it might support it. But I struggle with it on several levels. I

am afraid that I will generate just as much bad karma doing this as I

would by " firing " half of my patients (or leaving town), because

probably that many will still feel like they are now without a doctor.

And I would think that my practice would turn into an urgent care

clinic as people would not come in for wellness visits and only for

sick visits when the other offices are full.

Has anyone made the leap from too-busy practice to cash-based practice

and have any comments? For that matter, has anyone in the group made

the Gordon--Practice-Conversion from a full, too-busy practice?

How do you slow things down once they're out of hand?

Thanks for the advice!

Greg Hinson