Letters: Readers comment on Medical Economics stories

Be your own boss

Congratulations to Kevin Deighton, MD, and his colleagues for proving once again that physicians, armed with some basic business and management skills, often do a better job managing practices than hospital executives do ["Practicing Excellence: Infinity & beyond," June 19, 2009].

I have also learned that lesson-twice! In 1996, I sold my successful practice to a university system. It took only four years for them to destroy it and throw me under the bus. Then I went to business school and rose through the ranks of physician executives to become CEO of a large hospital, only to be thrown under the bus a second time. Now I own and run my own enterprise that includes a near "utopian" practice as described by Jason Kessler, MD, elsewhere in the same issue ["Coming of the utopian practice"].

To be successful today, one must have a firm grounding in business and practice management, and be fully committed to a digital future. How many times have we seen formerly employed physicians regain control of their practices and within a few months earn more than they did as employees? We may soon see a wave of "re-privatization" as more physicians realize that working for hospitals can be a huge mistake.

MICHAEL A. PATMAS, MD, MMM, CPE, FACP, FACPE
Eagle, Idaho

Encouraging signs

I enjoyed your "Infinity & beyond" article in the June 19 issue. I have been made aware of physician clients being approached by a local hospital that's looking to acquire physician groups-a business model that is rearing its head once again, according to many consultants I've talked with recently.

Your article and the physicians at Infinity Primary Care offer encouragement to those who question whether it is possible for physicians to maintain an independent, physician-run practice in the future. Looks like it is very possible! Thanks for the perspective.

MICHAEL L. DEVRIES, CHBC, CFP, EA
Grandville, Michigan

Sick or not sick?

"Dodging danger" by Lee J. Johnson, JD, is true throughout, and I live by her dictum that "five minutes documented now beats five hours in a courtroom defending a possible lawsuit" [CME, June 19, 2009].

However, the axiom "If it wasn't documented, it didn't happen" is prima facie false and is one of the major sources of stress for practicing physicians. The reason that this dictum is false is that there are so many subliminal exchanges that take place during a patient-physician visit that it is impossible to record them all, as many of them never reach the level of consciousness.

As a primary care physician, my first diagnosis is "sick or not sick," and very often the clue to that is a subtle tone of voice or change in body language. If I were to record all of that, I could see one patient a day!

JOHN R. DYKERS JR., MD
Siler City, North Carolina