“Time off? Surely you jest,” wrote C.K. Hebdon, MD, in response to Physicians Practice’s query about going on vacation. Hebdon is the owner and sole physician at the Center Performance & Longevity in Salt Lake City. An addiction medicine specialist, he says there is no other nearby specialist who can cover his clinic when he leaves, so he rarely takes time off from his practice.
“And if I take a day off, I’m punished by having to fit in that day’s patient load into the surrounding days,” he notes. “Monthly visits and prescriptions must be maintained.”
In Physicians Practice’s 2018 Great American Physician Survey, 29 percent of respondents reported they’re the only physician at their institution. Those doctors are opting for the flexibility and increased freedom to spend more time interacting with their patients, a perk that often comes with a small private practice.
But for solo practitioners, that freedom comes with the responsibility of ensuring revenue levels are maintained and patients can get the medical help they need, when they need it. That can cause solo practitioners to avoid taking time away from the office, which can lead to burnout.
“The fear is, if you’re not there, then you’re not making money,” says David Hicks, DO, who runs West Coast Family Medical Care in Clearwater, Fla. “But your health is more important, and I think burnout is a huge thing for solo practicing physicians.”
Matthew Bates, the managing director of healthcare practice for Huron, a global management consulting firm, relates the story of a solo practitioner who drives to all of his vacation destinations. The doctor plots his course so he constantly has cell phone coverage in case someone at his office needs something.
“That’s incredible dedication. But he’s 40-something, and he says he’s burning out,” Bates says. “His marriage is struggling, and he’s disconnected from his family. He’s not sure how much longer he can keep going with that lifestyle.”
On the rare occasion Hicks goes on vacation, he carries two cell phones and two smart watches that can make and receive phone calls. That way, he’s always accessible. “I never go anywhere without them,” he says. “Not that they ever ring, but if they do, I have them. They’re just part of me.”
Being completely unavailable to the office isn’t an option for most solo practitioners. Even so, they can strategize ways to physically escape the daily grind and maximize the mental break they get while away. It all comes down to a foundational strength of solo practices: relationships.
Relationships with patients
Erinn Harris, MD, is the entire office staff at Harris Internal Medicine, her micro direct primary care practice in Tyrone, Ga. She maintains regular clinic hours, but when she’s not in the office, it’s closed. Because she and her patients have a relationship built over one-on-one interactions, they understand her need to take time off. They’re even forgiving when she has an emergency and has to close the office suddenly.
That type of patient relationship is common in traditional payer-based practices, too. Because they’ve gotten to know each other over time, patients see those physicians as actual, real people with a personal life. Patients recognize they can often place demands on their physician’s personal time, so they’re usually understanding when their physician wants, or needs, to take some time off.
Deborah Winiger, MD, who runs North Suburban Family Healthcare in Vernon Hills, Ill., says the relationships she has built with her patients cause them to naturally be more respectful of her time when she’s out of the office, so they tend to avoid calling her outside of office hours. When they do, they keep the call brief.
Part of that is the nature of a solo practice. Patients know that if they leave a message with a solo practitioner’s office, they’ll get a call back the next morning, which isn’t always the case with larger group practices.
Most solo practitioners work hard to accommodate their patients before they leave the office for an extended time. They give patients plenty of notice that they’ll be out of the office, and they often load up extra patients in their schedule before and after vacation.
“Even if I’m gone for the week, revenue for the practice tends to not be down that much, because I end up working harder on both ends of the vacation,” Winiger says.