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Amidst healthcare reform, ACOs, and watching primary care colleagues select employment over independence, I wonder whether solo practice is still for me.
With the arrival of August 2012, I have just celebrated my ninth year of solo practice in my hometown in southwestern Virginia. As I grew up and progressed through high school, college, medical school, and eventually residency, all roads eventually lead to where I began. At present, I am still practicing solo family medicine and I could not love it more.
As the waves of healthcare reform wash up on to a beach near you, there are various struggles that I am facing now that were vastly different compared to August 2003. My office manager is still with me. My original nurse that worked for me for 8.5 years has passed on to Heaven. I have been very fortunate to have such a demand for care in the office that I have had to expand my practice from three employees in 2003 to a total of 11 at present. I have two nurse practitioners and I supervise them in the office on a daily basis. Having mid-level providers has been very beneficial for my practice. I am able to offer patients same-day access for call in visits. Since I am male, several of my female patients are reluctant to have their gynecological exams performed by me, and my two female nurse practitioners are able to complete this task. One nurse practitioner favors adults while the other favors children. Having nurse practitioners provide patient care has been very well received in my practice.
I still perform screening colonoscopy and EGD exams on a weekly basis. My patients like the fact that they can have such screening procedures completed by their physician without having to travel long distances to see a specialist. They also enjoy not having to pay the additional costs associated with seeing a specialist provider. Incorporating procedures into my practice has not only allowed my practice to be financially stable, but it has provided a very high level of patient satisfaction as well.
There are times, however, when solo practice can be very challenging. Certainly the summer months find many patients feeling well and free of illnesses. With so many patients having no need to call us for same-day access, it can cause the daily workload to be lower than what we traditionally see in the colder months. Unfortunately, the expenses remain the same. There is no respite for paying the rent, health insurance premiums, and the associated overhead that medical practices assume on a daily basis. We have accepted the slower summer months with open arms and have chosen to place an extra focus on promoting screening and annual physical exams during these times.
Being a solo practitioner, I am not subjected to answering to practice administrators and corporate professionals when it comes to meeting a certain daily census of patients. After encouraging patients to come in for well exams and the other preventive services we offer, sometimes the daily workload is just not what it needs to be. This is especially true for the summer months as described above. On days when we find ourselves not quite as busy as we would like to be, I choose to let my staff go home a bit early and enjoy the nice weather. The trade off for these nice days in the summer is the additional hours that are sometimes required in the winter months when our call in volume is especially high. My staff understands that I have expenses to pay and they are very determined to put in the extra time when needed.
At present, I choose to remain in solo practice, especially when many of my colleagues in primary care are seeking the stability and assurance of employed practice. I am able to earn a good living, am able to provide the care for my patients that is needed, and I feel that at present the pros of solo practice overwhelmingly outweigh the cons. While I am uncertain of the direction my practice will take in the coming years, I will choose to remain in solo practice. Healthcare reform, accountable care organizations, and other projects to be implemented will certainly affect my practice, but I will address each challenge as it presents and continue to do the best that I can do in the occupation that God has chosen for me.
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