Making the Solo Practice Work: Invest in Yourself

So, you want to fly solo? For physicians who are trying to maintain a solo practice, the challenges are daunting. According to a November 2008 report from The Physician’s Foundation, nearly half of the physicians surveyed—or approximately 150,000 practicing doctors—say that over the next 3 years, they plan to reduce the number of patients they see or quit the practice of medicine outright.

The key reasons for dissatisfaction, according to the report, are “increased time dealing with non-clinical paperwork, difficulty receiving reimbursement and burdensome government regulations.”

James Langabeer, MBA, CMA, an associate professor of management and finance at the University of Texas at Houston, School of Public Health, is not surprised. “The economy is not helping anyone,” Langabeer says, “And the solo practice probably has one of the most difficult challenges. When the economy goes bad, they don’t have as many options as some larger groups do.”

Reimbursement slowdown

Langabeer, who is also the author of Healthcare Operations Management (Jones & Bartlett), believes that lower reimbursements, and the reduced speed with which they are being paid, is the key challenge facing solo practicing physicians.

“What the large health plans are doing is slowing down some of the timing of their payables,” Langabeer explains. “So, from the physician side, the spread in between when they deliver the service and when they see cash in the bank, is increasing.”

Langabeer says he hasn’t seen any evidence of physician practices being marketed and shopped around as solo practitioners seek to close their doors. Most physicians, he says, are trying to weather the storm. However, he has seen that larger groups view the current climate as an opportunity to acquire smaller practices. “I don’t know if that’s good or bad for physicians, because it’s all based on their own business model and how independent they want to be over their own practice,” he explains. “But there are large groups saying that now is a good time to be buying and expanding.”

What’s a solo practitioner to do? Langabeer uses the analogy of the stock market and investing guru Warren Buffet. In a downturn, you do the contrary; meaning, you buy when everyone else is selling. For physicians, that means investing in themselves.

Bucking the trend

At a time when solo practitioners are merging to take advantage of the “safety in numbers” philosophy, Anita Montes, MD, has gone in the other direction. An OB/GYN who had been delivering babies for 25 years, 19 of them as part of a large practice, Montes went out on her own about 18 months ago, launching Hickory, NC-based Adolescent & Adult Women’s Care. She says it was a way to get her life back.

“I was taking a call every third night, which means, every third night you’re up all night delivering babies,” Montes says. “It was fine when I was in my 30s and 40s, but when I hit my 50s, it was really tough to bounce back from the lack of sleep.” She took the plunge. Her husband works in the front office, and she has three other staff members—none of whom had ever worked in an office before. “There was a very steep learning curve. It was tough for everybody.”

The key to making things work, she says, was using an electronic medical record from Practice Partner, part of the McKesson Corporation. “To make ends meet as a solo practitioner, where all the overhead is your own, you have to be making some dollars. And that means you have to see a good amount of patients.” The EMR, Montes says, enabled her to move through the day without skipping a beat or forgetting something. “It made my life better, I get better reimbursement because my notes are much better, and the patients get better medical care.”

Outside the box

Langabeer admits that it’s difficult to think about spending money as a solo practitioner when cash is being constrained and margins are going down, but he insists it’s still the best way to go. “I’m getting a ton of calls right now from physicians who want to know how to streamline some of their process flows, and automate some of the things they’re doing,” he says. “Use this time as an opportunity to fix some of the problems by investing in the practice.”

Montes agrees, and says that if you have a good product, patients are going to come to see you. “People miss that up-close-and-personal feeling with their doctor,” she explains. “When patients come into my office, they’re seeing me, not a physician assistant, because I don’t have one. There are patients out there who want that and are willing to pay for that. So, even though you have to stay busy and it’s a lot of work, I think it’s very much worthwhile.”

Ed Rabinowitz is a veteran healthcare writer and reporter. He welcomes comments at edwardr@frontiernet.net.