A Tale of Two Medical Practices

Two recent encounters with solo medical practices demonstrated to me the stark contrast between a medical practice business model stuck in the 20th century and that of one that has boldly stepped into the 21st century.

A New York Times article of a month ago profiled Dr. Ronald Sroka, a solo practicing family physician in Maryland whose life as a doctor had deteriorated to the point that he elected to retire at around age 62, and sell his life-long family practice.

Selling the practice proved an impossible task, however, as the younger generation of doctors had no desire to acquire a 4,000-patient medical practice with significantly declining revenues and the prospect of long working hours to compensate. According to the Times article:

“Had he left a decade ago, Dr. Sroka might have been able to persuade a doctor to pay $500,000 or more for his roster of 4,000 patients. That he cannot give his practice away results not only from the unattractiveness of its inflexible schedule, but also because large group practices can negotiate higher fees from insurers, which translates into more money for doctors.”

In other words, this practice had no value in the marketplace!

It's not hard to see why, with clues coming from the following paragraphs:

“On most days, visitors are greeted by Betty Alt, a sweet 68-year-old who knows many patients intimately. Patients’ medical folders -- many bulging with decades of aches and test results -- are retrieved by Jennifer Simmons, a 41-year-old office assistant who spends much of her day faxing. Before appointments, patients often give a urine sample to Chris Minner, 58, a medical technician.

“Altogether, Dr. Sroka employs 10 part-time employees, or the equivalent of five full-time workers. He does not provide his staff members with health insurance. His expenses amounted to $420,000 last year, or about $200 an hour. Most of his patients have either Medicare or CareFirst, the local Blue Cross Blue Shield plan, which pays him $69 (including a $20 co-pay) for most consultations. At that rate, he breaks even at three visits an hour and needs a fourth to turn a profit.”

Underutilization of technology — he doesn’t use an emergency medical records (EMR) system -- overstaffing, and a huge overhead have clearly contributed to this practice's demise.

Let's contrast this older doctor's practice with that of a physician of a similar age.

Internist and nephrologist, Dr. Robert Novich, with whom I had the pleasure of doing a podcast several weeks ago tells a very different story.

Facing the same problems in his solo medical practice, Dr. Novich began digitizing and automating as much of his workflow as possible, many years ago when he spotted the potential of computers to streamline his practice operations.

In doing so, he was able over time to eliminate costly overhead in the form of staff, misplaced medical records and documents, and hours spent trying to communicate by phone with patients.

Together, he and his son Jeffrey Novich built the platform off of which he runs his solo medical practice (also known as a "micro-practice"), and they are now offering their services to colleagues in the form of a web-based, patient-communication tool, Patient Communicator.

Talk about necessity being the mother of invention!

If you haven't already done so, I'd encourage you to listen to his inspiring tale of transformation. Then ask yourself and your physician colleagues, "How must we adapt to bring our medical practice into the 21st century, in order to not only survive but to thrive?"