It’s been over a month since I joined the ranks of the unemployed and started building my new practice.  For not having a job I’ve kept very busy.  Here’s what I’ve done.

I presented the idea of my practice to about 150 people.

It was a wonderful experience, and was quite emotional for me seeing a bunch of patients in one place.  The reception was wonderful.  I was hoping to get a video of this up, but the fates were fickle and it was not possible.

I wrote a business plan

My accountant didn’t even laugh when I showed him.  The idea was to look ahead at my months ahead and see when things would become profitable.  There are a bunch of huge questions that my affect this: how many staff I have, how many patients I have, what it costs to upgrade my office space, but I did a worst-case scenario (short of the Zombie Apocalypse) and the fact that my overhead is low makes it easy to be profitable quite quickly.

I got a location for the practice.

Today I went through the building with a designer and am working on getting it ready to use.  I am not doing the whole renovation at the start, as I won’t really know what the practice will need until it’s up and running.  I want it to be very comfortable and welcoming.  Most doctor’s offices are not places that say “welcome” to patients, but that’s what I want to convey.

I set a fee schedule.

· Age 0-2: $40/month
· 3-30: $30/month ($10/month if they are away in college)
· 30-50 $40/month
· 50-65 $50/month
· 65+ $60/month

Family maximum will be $150/month

Registration fee is $50 for 0-30 years of age and $100 after that (will count as first month’s payment).
$200 Family maximum for registration.

I am really trying to keep it as affordable as possible, especially for families.

I chose my computer platforms.

This was a particularly difficult step, as no one platform did everything I need to run this type of practice.  I have signed with eClinicalWorks for the EMR side of things, and am working with Avado to get the patient health record and communication tools I need for patients.  eCW has a portal, but portals are not the same as PHR’s, as a PHR is a more complete record which the patient owns, while a portal is an area where the patient is “permitted” to see information in the EMR.  I have one more piece of the puzzle I am working on, but am not ready to announce that.

Played my guitar

One of the sure signs that my life is getting back in order is that I am playing my guitar.  I’ve played since I was in 4th grade, and actually got pretty good at it.  For the past few years, however, my playing has diminished to near nothing.

Ran/hurt myself running

I’ve been trying to get back into shape, but Father Time played a trick on me.  I was running between 12 and 15 miles per week up to a week ago, when I got a bad pain in my gluteus maximus region.  I hope it’s just a pulled muscle, and not something more sinister, like a radiculopathy (nerve pain).  It is slowly getting better, but I hate having to limp around, and hate more to be sedentary for the past week.

Dealt with a sewer back-up

We literally had to deal with a bunch of crap in our basement.  I won’t go into details, except to say that I gained respect for the plumbing profession (and pity).

Home brewed beer

My son and I have been brewing our own home-brew: “My Little Pony Beer.”  It’s quite fun and so far nobody has gotten injured or sick in the process.  I am presently waiting on a Belgian Ale to finish carbonation (already having fermented).  It’s major yums.

I have hired someone to revamp the website (and my blogs)

My website will be as important to me as my office space, since I am going to be relying on it for patient communication.  I’m spending money to get it nifty looking (no flash, thank you), and have lumped this and the other blogs with the project.  More to follow.

So I am feeling OK overall about what I’ve done so far.  Last month was about setting the foundation, and this month is getting things done.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind)where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player.  He is a primary care physician.

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10 Responses for “The Doctor Is In”

  1. BobbyG says:

    Good luck to you, sir.

  2. Peter1 says:

    “I presented the idea of my practice to about 150 people.”

    Sounds like all at once? Old patients, new contacts? How. Did you get the list?

    Nothing sinister, just interested.

  3. Rob says:

    All at once, old patients, and about 70% were ready to sign up. I also got a message yesterday from a business of 120 employees (unsolicited) that wanted to discuss me doing the medical care for their business along with a high-deductible insurance plan. I am not sure I am ready to go there yet, but it impressed me that without advertising the word has gotten out enough to get this sort of offer.

    Peter, I don’t take anything personal, so the last line was not necessary. I would rather have my ideas challenged and doubted and have to explain and defend them. Don’t be afraid to comment on my stuff even if it is negative.

  4. John Irvine says:

    Not sure how you’d feel about this (I can see both pro and con arguments) but I think you may want to consider posting your business plan online for input. How would you feel about doing something like this?

  5. Ed Bertels says:

    Love your concept. Check ours. What do you think?

    ed

  6. John Irvine says:

    Okay, so this has really got me thinking

    Here’s another idea that I like a lot – set up an online calendar and open up a few strategically selected blocks of time – say weds afternoon – friday morning or whatever works  - and allow people to book their own appointment slots (think Southwest) and make some changes

    didn’t see anything about this on the threads – but could eliminate some of the scheduling inefficiencies

    in theory, anyway …

    does avado do this? otherwise I’d probably recommend experimenting with either tungle or google docs

    • John, scheduling appointments online is becoming more and more common nowadays. The more comprehensive EHR tethered patient portals had this ability for a while, but providers were a bit “tentative” about using it.
      Do a search for “schedule appointments online MyChart” for example. This is the Epic portal so you’ll get the big guys (Sutter, Partners, Swedish…), but smaller ones do it too. Saves tons of time and makes patients very happy….

  7. bird says:

    congrats on doing what alot of us dont have the courage. your basic plan will work, has a track record of working and has been one of the few medical models that actually do show higher quality and lower cost. Down side will be with gov’t sees this as a trend then legislation will follow. Your model eliminates too many middlemen and as we all know it is the middlemen that are calling the shots.

  8. sm2012 says:

    Rob, I’m curious as to how you are apportioning your time. For example, as you consider whether or not to take on the small business that you referenced, how do you decide the amount of time to set in reserve given the number of employees in their business. Is it a guestimate based on age and likelihood of needing care/ the amount of care, or is there a more sophisticated actuarial modeling process? The corollary of this question of course is how do you assess a value on your time to determine the charges you listed?

    Good for you for making the leap!

  9. ehp2013 says:

    Just curious if you looked at Relay Health, a McKesson product. It allows secure communication between pt and provider, provider to provider, self-pay collection by pts and electronic prescribing and other things, too. I work in a system that uses it, albeit only for secure messaging between pts and providers, but have been impressed with the other things we could do with it.

    Congrats on organizing some chaos in the world of health care.

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