Pediatrician and Air Force Captain Terence R. McAllister started to think about his post-military employment options in the summer of 2003. Although he still owed another three years to Uncle Sam, a strong desire to settle with his family in his home state of Massachusetts sparked some serious discussions with his wife (that would be me).
In 2000, when Terence proposed marriage to me, he changed not only my life, but my location and my career trajectory as well; all with a promise to both of us that we’d return to Massachusetts in 2006 when his military commitment ended.
In 2003, as we drove to our new assignment at Kirtland Air Force Base in Albuquerque, N.M., Terence turned to me, and asked: "Can you run a small practice for me?" And just like that, my husband changed my life yet again.
If we were going to do this, I laid out a few non-negotiable points (they are the same now as they were then):
1. As business partners, we must wear separate hats; as medical director, Terence takes the lead on all medical-related decisions. I, as administrative director, call the shots when it comes to business decisions.
2. Work-life balance is a must. While some nighttime and weekend call is expected, we set boundaries to make time for each other and our son.
3. Although we accepted that we’ll never earn enough to be in the top 1 percent, it is important to us that we earn as much as we could at our own business as we could employed by others.
As Terence military commitment kept him busy, I attended the University of New Mexico to obtain my master’s degree in business administration.
While there, most classes required small groups of students to work on a project. When my classmates looked at each other with a, "I dunno, what you want to work on?" expression, I’d ask, "How about a small primary-care pediatric practice?" And, with each class (operations, marketing, finance, and human resource), my business plan was created.
Like any business innovator, I did a lot of research and questioned everything from the role of traditional nurses in primary care to the positives and negatives of a cash-only practice. I took on consecutive part-time jobs, first as an entry-level medical records clerk at a traditional 11-provider practice and then as an office assistant in a small, home-based practice to observe what works (and what doesn’t) firsthand. In my research I learned of micropractices, two or three providers who work without medical assistants. The providers in micropractices see fewer patients a day than most doctors and spend more time with each patient. For Terence, practicing medicine in the gigantic bureaucracy of the U.S. military made him miserable. I knew he’d be happier at a small practice.
The key would be — and still is — to keep overhead low and profits high by limiting staff and utilizing technology to work efficiently. We started, from day one, as a paperless practice with an integrated practice management and EHR called Office Practicum. In 2010, we added the InstaMed clearinghouse because it integrated into our EHR system. Today, we feel we have the right technology tools working for us.